Benign Metastatic Leiomyoma Derived From Uterine Leiomyoma

OBJECTIVE: The clinical data of a patient with PBML(pulmonary benign metastasizing leiomyoma,PBML)were analyzed.At the same time,we reviewed the relevant literature at home and abroad,combined with 222 cases reported in the literature,a total of 223 cases were summarized and analyzed.To understand the history,clinical manifestations,imaging findings,pathological features,treatment and prognosis of patients with BML(benign metastasizing leiomyoma,BML)derived from uterine leiomyoma,and to provide reference for clinical diagnosis and treatment.Methods: 1.Retrospectively analyze the clinical manifestations,imaging findings,pathological features,and clinical data of a patient with benign metastatic leiomyoma of the lung diagnosed and treated in our hospital.2.The relevant case data were searched through network resources.These databases,including Pub Med,CNKI,Wanfang and VIP,were published until 2019.By reading the full text,articles related to "benign metastatic leiomyoma,consider the origin of the uterus" were included.According to the inclusion and exclusion criteria,duplicate literatures were excluded and 222 cases were included.Combined with 1case treated in our hospital,a total of 223 cases were collected and analyzed.Result :1)The pathological diagnosis of the patient was confirmed by PBML.She was a premenopausal woman with bilateral pulmonary nodules found by physical examination outside the hospital.Benign pulmonary nodules were considered by PET/CT examination and lung biopsy was diagnosed as PBML.When admitted to our hospital,there were no obvious clinical manifestations and signs,and transabdominal total hysterectomy and bilateral adnexal resection were performed.There was no hormone therapy after operation,and menopausal syndrome appeared 2 months later.During the follow-up for 6 months,the condition was stable and there was no progress of pulmonary nodules.The condition was stable and there was no progress of pulmonary nodules.2)Literature analysis of 223 cases:(1)All the patients were female,and the age of onset was mainly in the age of 40-50,and 163 cases were 50 years old and before 50 years old,accounting for 73.1%.(2)221 cases had a history of uterine leiomyoma(99.1%)and 188 patients had a history of uterine leiomyoma surgery(84.4%).In the history analysis,the older the patients with uterine leiomyoma,the more likely they were to choose surgery that did not retain the uterus,such as total hysterectomy or subtotal hysterectomy.The median interval from the first hysteromyoma operation to the diagnosis of BML was 108 months(60~156).There was no difference in the interval between the first operation and the diagnosis of BML,regardless of whether the uterus or ovaries were preserved.However,the interval was longer in patients with recurrence of uterine leiomyoma.(3)56.1% of the patients with BML had symptoms.Cough was the most common symptom,and dyspnea was the second most common symptom.Its metastatic site was widespread,the lung was the most common metastatic site,and the subcutaneous soft tissue was the second most common.Lung metastasis occurred in 200 cases,most of which were in both lungs.The CT findings of the lungs suggested that most of the metastatic lesions were multiple nodules and a few were solitary nodules.In addition,pulmonary nodules can be associated with cavities,cystic degeneration and calcification,rarely involving hilum and mediastinum,and pleural effusion.(5)The histopathological features of BML were similar to those of primary uterine tumor.The results of estrogen receptor(ER)and progesterone receptor(PR)were described simultaneously,and both ER and PR were positive for94.2%.(6)Surgical resection of BML tumor was performed in 129 cases(57.8%),which was still the main treatment.Among them,5 patients chose ovariectomy again because of poor treatment effect,and then the condition was stable.69 cases(30.9%)were treated with hormone,most of which were treated with aromatase inhibitors and gonadotropin releasing hormone analogues.(7)The follow-up data of 152 cases were recorded in detail,and the median follow-up time was 13 months.134 cases had a good prognosis(88.2%),18 cases(11.8%)progressed,13 cases had tumor enlargement or new lesions at the metastatic site,and 5 patients died.CONCLUSION: All patients with uterine-derived BML were female and frequently occurred before the age of 50.It usually occurred in patients with a history of uterine leiomyoma and a history of hysteromyoma surgery.The symptoms were not typical,and the lungs were common metastatic sites,so respiratory symptoms were common.The imaging findings were similar to benign tumors and had no specificity.The pathological features of metastatic tumors were similar to those of uterine leiomyoma,and most of them were positive for ER and PR.There was no uniform treatment,surgical resection of BML was still the main treatment,often combined with endocrine therapy.Ovariectomy seemed to be more conducive to the control and development of the disease.Most of the BML had a good prognosis,and a few had progression or even death.Its pathogenesis was still unclear,and molecular biology in recent years more supported BML as a benign metastatic leiomyoma of uterine origin.