Lobe (Figure 3). The patient underwent myomectomy at the age of 42 years
Lobe (Figure 3). The patient underwent myomectomy at the age of 42 years and total abdominal hysterectomy at the age of 43 years, due to recurrence. There was no significant family history. The patient had no PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26024392 pulmonary symptoms. Chest CT showed a 2.5-cm well-defined round nodule with poor contrast enhancement in the left lower lobe and a smaller well-defined ovoid nodule in the right upper lobe. The patient underwent a video-assisted thoracoscopic wedge resection of the left lower lobe and right upper lobe.The mass shows a irregular pale brown tissue fragment (Figure 4). Pathologic diagnosis was leiomyoma of the lung. Immunohistochemical staining was positive for desmin and actin (Figure 1e). Transvaginal sonography showed no abnormal findings other than atrophic ovaries. Because the patient was perimenopausal, we decided to monitor her for the progression of the disease. She was healthy without evidence of progression of disease 2 months following the purchase TAPI-2 surgery.CaseComputed tomography showed a 10.5 ?10.5 cm heterogenous, low-density lesion on the right side of the uterus and multiple low-attenuated foci on the left side. There were multiple small nodules in both lungs. The patient underwent total abdominal hysterectomy along with left adnexectomy. She underwent lung needle biopsy of the multiple nodules. Pathologic diagnosis was leiomyoma of the uterus and lung. Immunohistochemical staining was positive for actin ,desmin,estrogen receptor and progesterone receptor (Figure 1f,g) PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/25609842 Ki-67 is less than 1 (Figure 4h). We decided to observe the residual lung lesion. The patient was healthy without recurrence, for 2 years following the surgery.Discussion Benign metastasizing leiomyoma is a uterine leiomyoma with pulmonary metastasis occurring in young adulthood, especially during the premenopausal period.A 48-year-old nulliparous perimenopausal woman visited our clinic with a huge abdominal lump. She was diagnosed with systemic lupus erythematosus and underwent uterine myomectomy. She had undergone uterine myomectomy 11 years back. Uterine myoma recurred 1 year ago.Figure 3 Chest radiograph. There is a 2.6-cm well-defined oval mass in the left lower lung (white arrow) and a small ovoid nodule in the right upper lobe field (arrowhead).Ki et al. World Journal of Surgical Oncology 2013, 11:279 http://www.wjso.com/content/11/1/Page 4 ofFigure 4 Photograph of a lung nodule. An irregular pale brown tissue fragment, measuring 4.0 ?0.5 cm.Martin [13] classified leiomyomatous lung lesions into three categories in 1982: (1) BML in women, (2) metastatic leiomyoma in men and children, and (3) multiple pulmonary fibroleiomyomatous hamartoma, occurring in any subjects. The author reported that these are all pathologically identical but, on the basis of clinical manifestations, BML and multiple pulmonary fibroleiomyomatous hamartomas are separate disease entities. In this study, the BMLs of the lung in women were hormone-sensitive, so they have good prognoses. The pathogenesis of BML of the lung has not yet been completely identified. Various pathogenetic mechanisms have been proposed: hormone-sensitive in situ proliferation of smooth muscle bundles [14], benign smooth muscle cells transported from a uterine leiomyoma and colonized in the lung, and low-grade uterine leiomyosarcoma metastasized to the lung [15]. The possibility of surgically induced mechanical displacement from the preexisting benign uterine tumor has been suggested because BML usually develops.
