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Vol.60 No.5 contents

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- Case Report -

A Case of Pulmonary Benign Metastasizing Leiomyoma Accompanied by Local Recurrence Nine Years After Myomectomy of a Uterine Leiomyoma

Miku Kuriki¹, Toshihiko Yokoyama², Masafumi Ito³, Masayasu Inagaki², Mari Tanaka², Yuiko Yokoyama², Haruka Machii², Takashi Kounou², Fumio Nomura^2
1Department of Respiratory Medicine, Tokai Central Hospital, Japan, ²Department of Respiratory Medicine, ³Department of Pathology, Japanese Red Cross Nagoya Daiichi Hospital, Japan

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Background. Benign metastasizing leiomyoma (BML) is a rare disease in which a histologically benign uterine leiomyoma metastasizes to other organs. Case. A 44-year-old woman with a history of myomectomy for a uterine leiomyoma at 35 years old was referred to our department because of abnormal chest radiographic findings obtained at a medical checkup. Chest computed tomography revealed multiple small round nodules with smooth margins in the bilateral lung fields that gradually increased over follow-up of one year. A thoracoscopic lung biopsy was performed, and histopathological and immunohistochemical analyses revealed a BML originating from the uterine smooth muscle. The pathological findings were consistent with the histology of the uterine leiomyoma resected nine years earlier. Subsequent pelvic magnetic resonance imaging showed local recurrence of the submucosal uterine myoma. Furthermore, pseudomenopausal therapy with a gonadotropin-releasing hormone agonist for six months reduced the submucosal uterine lesions and multiple pulmonary nodules, but the lung lesions increased again after switching to progesterone preparation therapy. Conclusions. Our review of 26 cases of BML reported from 1994 to 2016 in Japan showed that approximately 80% of patients had a history of surgery for a uterine myoma, with an average time to the postoperative BML onset of 11.3 years. Although the medical history of uterine leiomyoma may occasionally be regarded as unimportant, this history is necessary to consider when differentiating BML, especially in patients with a history of surgery.
key words: Pulmonary benign metastasizing leiomyoma, Uterine leiomyoma, Myomectomy, Local recurrence, Gonadotropin-releasing hormone agonist

Received: March 24, 2020
Accepted: June 26, 2020

JJLC 60 (5): 416-422, 2020