A rare case of pulmonary benign metastasising leiomyomatosis in a woman with a previous history of hysterectomy for uterine fibroids

Clin Med (Lond). 2023 Jan;23(1):78-80. doi: 10.7861/clinmed.2022-0468.

Abstract

Benign metastasising leiomyomatosis (BML) is a rare disease, predominantly seen in premenopausal women. It poses a diagnostic dilemma and can be misdiagnosed as malignancy. Here we present a case of 41-year-old woman with a previous history of hysterectomy 10 years ago for multiple fibroids. She presented with shortness of breath and chest discomfort. Chest X-ray showed pulmonary infiltrates. She was diagnosed with sarcoidosis and treated with steroids without any improvement. Further investigations including CT scan and bronchoscopy and lavage failed to confirm a diagnosis. Subsequently she underwent video-assisted thoracoscopic surgery and histopathology revealed leiomyomatosis (so-called leiomyomatous hamartomas/benign metastasising leiomyomatosis). Oestrogen and progesterone receptors showed diffuse and strong nuclear staining. The patient was commenced on tamoxifen and a repeat chest X-ray in 8 weeks showed significant improvement. In women of reproductive age with previous hysterectomy and multiple lung nodules on imaging, the diagnosis of BML should be taken into consideration.

Keywords: leiomyomatosis; uterine fibroids; uterine leiomyoma.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Female
  • Humans
  • Hysterectomy
  • Leiomyomatosis* / surgery
  • Lung Neoplasms* / diagnosis
  • Multiple Pulmonary Nodules* / diagnosis
  • Multiple Pulmonary Nodules* / surgery
  • Uterine Neoplasms* / surgery