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Liu Y, Li D, Li X, Wang J, Wang J. Benign Metastasizing Leiomyoma: Is "Wait and Watch" Strategy Feasible? Reprod Sci 2023; 30:3568-3577. [PMID: 37531066 DOI: 10.1007/s43032-023-01314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
Benign metastasizing leiomyoma (BML) is a rare disease that affects women with a history of uterine leiomyoma. The aim of this study is to investigate the clinical characteristics and outcome patterns. We collected 385 cases from previous reports indexed in PubMed and Google Scholar and made a thorough review. All relevant clinical parameters were carefully reviewed, including age at diagnosis, clinical presentations, course of disease, medical history, imaging, molecular tests, treatment, and outcomes. Univariate survival analysis was performed to investigate the effects of treatment strategies on outcomes. The mean age at diagnosis was 46.2 years. The most common site for the metastasis was lung, and followed by abdomen/pelvis/retroperitoneum, bone, lymph nodes, and heart. The medical histories and molecular alterations were non-specific, and the pathogenesis was still unclear. Due to its unresectable nature, hormone deprivation treatment, including oophorectomy and hormone drugs, is the most effective strategy to reduce or delay tumor progression. The present study may provide a useful consultation for diagnosing and managing BMLs.
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Affiliation(s)
- Yixuan Liu
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China
| | - Dong Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China
| | - Xueqing Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China
| | - Jingnan Wang
- Department of Pathology, School of Basic Medicine, Qingdao University, No. 308 Ningxia Road, Shandong, 266071, Qingdao, China
| | - Jigang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China.
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Seong G, Ahluwalia S, Talabong DJA, Erdinc B, Mohiuddin A, Agaronov M, Chiu E. A Rare Case of Benign Metastasizing Leiomyoma Causing T11 Spinal Cord Compression: A Report and Literature Review. Cureus 2023; 15:e41875. [PMID: 37457601 PMCID: PMC10348347 DOI: 10.7759/cureus.41875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/18/2023] Open
Abstract
Diagnosis of uterine smooth muscle tumors depends upon histologic characteristics as both benign and malignant share clinical features such as metastases. A benign metastasizing leiomyoma is a rare benign smooth muscle tumor that metastasizes to extrauterine sites with simultaneous uterine leiomyoma or previously biopsy-proven leiomyoma during myomectomy or hysterectomy. Benign metastasizing leiomyoma metastasizes outside the uterus, predominantly to the lungs and lymph nodes. However, the involvement of other organs, such as the heart, liver, spine, and soft tissue, is also reported. Here, we present a case of a 42-year-old woman with a history of uterine leiomyoma with prior myomectomy and hysterectomy, who presented with worsening back pain and lower extremity weakness and was found to have an acute cord compression, a serious complication caused by mass effect and a medical emergency that requires prompt attention to prevent permanent spinal cord damage. Sacral soft tissue biopsy and T11 spinal bone biopsy both demonstrated leiomyoma with immunostains positive for desmin, smooth muscle actin, and positive estrogen and progesterone receptors. No atypia, necrosis, and mitosis were identified. The patient had hepatic and pulmonary metastasis on imaging. The final diagnosis was benign metastasizing leiomyoma. There is no standard treatment for benign metastasizing leiomyoma. Both surgical and pharmacological approaches are employed. Although most cases are benign, there is a possibility for life-threatening complications. Benign metastasizing leiomyomas can be considered when multiple soft tissue tumors are found in premenopausal women with a history of uterine leiomyomas. Multidisciplinary discussion between oncologists, gynecologists, and relevant specialists is crucial in the optimal evaluation and treatment of benign metastasizing leiomyoma.
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Affiliation(s)
- Gyuhee Seong
- Department of Medicine, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | | | - Desiree Joy Anne Talabong
- Department of Pathology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Burak Erdinc
- Department of Hematology and Oncology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Amena Mohiuddin
- Department of Hematology and Oncology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Maksim Agaronov
- Department of Pathology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital, New York, USA
| | - Edwin Chiu
- Department of Hematology and Oncology, SUNY (State University of New York) Downstate Health Sciences University/Kings County Hospital, New York, USA
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3
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Su H, Fan R, Yang H, You Y, Zhu L, Feng F. Pulmonary benign metastasizing leiomyoma in patients aged 45 years and younger: clinical features and novelty in treatment. BMC Pulm Med 2023; 23:168. [PMID: 37189093 DOI: 10.1186/s12890-023-02406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Pulmonary benign metastasizing leiomyoma (PBML) is the most common extrauterine spread of uterine leiomyoma, and its biological behavior is traditionally thought to be hormone dependent. Studies on older PBML patients have been previously reported, but limited literature has been published regarding the clinical features and treatment of PBML in young women. METHODS A total of 65 cases of PBML in women aged 45 years and younger were reviewed, including 56 cases selected from PubMed and 9 cases from our hospital. The clinical characteristics and management of these patients were analyzed. RESULTS The median age of all the patients at diagnosis was 39.0 years. PBML most commonly presented as bilateral solid lesions (60.9%), with other rare imaging manifestations. The median interval time from a pertinent gynecologic procedure to diagnosis was 6.0 years. A total of 16.7% of patients received careful observation, and all achieved stable status in a median follow-up time of 18.0 months. A total of 71.4% of patients were administered anti-estrogen therapies, including surgical castration (33.3%), gonadotropin-releasing hormone analog (23.8%) and anti-estrogen drugs (14.3%). Eight of 42 patients underwent surgical resection of metastatic lesions. Patients who underwent curative surgery for the removal of pulmonary lesions combined with adjuvant anti-estrogen therapies had favorable outcomes compared with those who only underwent surgical resection. The disease control rates of surgical castration, gonadotropin-releasing hormone analog, and anti-estrogen drugs were 85.7%, 90.0%, and 50.0%, respectively. For two patients, sirolimus (rapamycin) achieved successful relief of symptoms and control of pulmonary lesions without lowering hormone levels and causing estrogen deficiency symptoms. CONCLUSIONS In the absence of standard treatment guidelines for PBML, maintaining a low-estrogen environment using different kinds of antiestrogen therapies has been the mainstream strategy and has satisfying curative effects. A wait-and-see strategy might be an option, but therapeutic approaches must be contemplated when complications or symptoms progress. For PBML in young women, the negative effect on ovarian function of anti-estrogen treatment, especially surgical castration, should be considered. Sirolimus might be a new treatment option for young PBML patients, especially for those who want to preserve ovarian function.
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Affiliation(s)
- Hao Su
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Rong Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Hua Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China.
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China.
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Hu Z, Liu K, Liu Q, Zhu H. Whole exon capture sequencing for identifying mutations associated with pulmonary benign metastasising leiomyoma. BMJ Case Rep 2023; 16:16/3/e251072. [PMID: 36948524 PMCID: PMC10040003 DOI: 10.1136/bcr-2022-251072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
A woman in her early 20s presented with cough and fever. She had undergone an abdominal myomectomy 3 years ago for uterine leiomyoma. Chest CT and positron emission tomography-CT revealed multiple round nodules in both lungs, suggesting metastatic lesions. A CT-guided lung biopsy was performed, and the tumour was diagnosed as pulmonary benign metastasising leiomyoma (PBML) based on pathological analyses. Whole exon capture sequencing of uterine leiomyoma and PBML sections revealed that 13 genes (MCM10, SLC16A9, RAG1, BAZ1A, NLRP2, TRMT61B, CPXM1, NGLY1, SUCLG2, FAM13A, CAGE1, PHTF2 and ZDHHC2) were concurrently present in the two tumours. The patient was prescribed goserelin injections every 4 weeks. The symptoms improved 2 weeks after starting the treatment. The lung nodules considerably decreased in size after three courses of goserelin treatment. The nodular size continues to decrease with the treatment.
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Affiliation(s)
- Zhijun Hu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Kaijiang Liu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Qing Liu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Hong Zhu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
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Savu C, Melinte A, Gibu A, Varban S, Duaconu C, Socea B, Dimitriu M, Balescu I, Bacalbasa N. Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence. In Vivo 2021; 35:2457-2463. [PMID: 34182531 PMCID: PMC8286492 DOI: 10.21873/invivo.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Leiomyoma is a rare benign tumor originating from smooth muscle fibres. In the respiratory tract, these tumors are rare and in the pleura, cases are exceptional, with only a few reported so far. This is the main reason we decided to present this case of primary leiomyoma of the visceral pleura. CASE REPORT We present a case of a 51-year-old asymptomatic patient who, during a routine medical examination using standard chest radiography, presented with a 3 by 2 cm homogenous mass in the right superior pulmonary area, tangent to the chest wall (same level with the 3rd rib). Further investigation using computed tomography (CT) in the chest confirmed the presence of a 31/18 mm solid mass in the right upper lobe, in contact with the parietal pleura. Surgery was performed for two reasons: i) removal of the tumoral mass and ii) establishing a histopathological diagnosis. Intraoperatively, a well-defined, homogenous, ivory white non-infiltrating mass was discovered in the right upper lobe on the visceral pleura and in close proximity to the minor fissure. The mass was removed with negative surgical margins and was left with healthy tissue. Histopathological examination and immunohistochemistry came as a surprise, establishing our diagnosis of leiomyoma. CONCLUSION Primitive pleural leiomyoma must remain a possibility when considering the differential diagnosis of pleural tumors. The main course of treatment is complete surgical resection. In our case, long-term follow up did not present any local recurrence.
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Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
- Department of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Alexandru Gibu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Stefania Varban
- Department of Pathology, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Camelia Duaconu
- Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Surgery, "St. Pantelimon" Emergency Hospital, Bucharest, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, "St. Pantelimon" Emergency Hospital, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
- Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
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Crispino P, Gino M, Barbagelata E, Ciarambino T, Politi C, Ambrosino I, Ragusa R, Marranzano M, Biondi A, Vacante M. Gender Differences and Quality of Life in Parkinson's Disease. Int J Environ Res Public Health 2020; 18:E198. [PMID: 33383855 PMCID: PMC7795924 DOI: 10.3390/ijerph18010198] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/05/2020] [Accepted: 12/26/2020] [Indexed: 12/15/2022]
Abstract
Parkinson's disease has been found to significantly affect health-related quality of life. The gender differences of the health-related quality of life of subjects with Parkinson's disease have been observed in a number of studies. These differences have been reported in terms of the age at onset, clinical manifestations, and response to therapy. In general, women with Parkinson's disease showed more positive disease outcomes with regard to emotion processing, non-motor symptoms, and cognitive functions, although women report more Parkinson's disease-related clinical manifestations. Female gender predicted poor physical functioning and socioemotional health-related quality of life, while male gender predicted the cognitive domain of health-related quality of life. Some studies reported gender differences in the association between health-related quality of life and non-motor symptoms. Depression and fatigue were the main causes of poorer health-related quality of life in women, even in the early stages of Parkinson's disease. The aim of this review was to collect the best available evidence on gender differences in the development of Parkinson's disease symptoms and health-related quality of life.
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Affiliation(s)
- Pietro Crispino
- Internal Medicine Department, Lagonegro Hospital, 85042 Lagonegro (PZ), Italy;
| | - Miriam Gino
- Department of Internal Medicine, Rivoli Hospital, 10098 Rivoli (TO), Italy;
| | - Elena Barbagelata
- Department of Internal Medicine, ASL 4 Chiavarese, Sestri Levante Hospital, 16039 Sestri Levante (GE), Italy;
| | - Tiziana Ciarambino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatrics Sciences, Marcianise Hospital, ASL Caserta, University of Campania “L. Vanvitelli”, 81025 Naples, Italy;
| | - Cecilia Politi
- Department of Internal Medicine, Veneziale Hospital, 86170 Isernia, Italy;
| | | | - Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital G. Rodolico, 95123 Catania, Italy;
| | - Marina Marranzano
- Department of Medical, Surgical and Advanced Sciences, University of Catania, 95123 Catania, Italy;
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
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Elmaci İ, Altinoz MA, Ozlu BEK, Sari R, Er O, Danyeli AE, Karaarslan E. Benign leiomyoma with multiple metastases to vertebrae and calvarium: An index case with comprehensive review of endocrine targets. Neurosurg Rev 2021; 44:289-300. [PMID: 32078084 DOI: 10.1007/s10143-020-01268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
"Benign" metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The reason to define these lesions as "benign" despite metastasis is their pathological features with low mitotic counts, lack of or minimal nuclear atypia, pseudocyst formation, and coagulative necrosis unlike leiomyosarcomas. Despite lack of pathological malignant features, they may cause significant morbidity and even mortality. Here, we describe a BML case with metastases to vertebrae and skull bones. Vertebral and skull metastases of BMLs were very rarely reported. In treatment of these tumors, hysterectomy and GnRH modifier treatments are widely employed. GnRH agonists act by desensitization and downregulation of the GnRH receptors, while GnRH antagonists act via the canonical competitive blockage. These treatments reduce FSH and LH levels, thereby reducing the systemic levels of sex steroids which stimulate leiomyoma growth. However, leiomyomas inherently harbor aromatase activity and synthesize their own estrogen; hence, treatment with systemic estrogen antagonists may provide better tumor control. Another important factor in BML pathogenesis is progesterone, and both progesterone receptor antagonists and high-dose progesterone receptor agonists may reduce BML growth. Following surgical treatment of the calvarial mass and radiotherapy of the vertebral metastatic foci, our BML case was successfully managed with hysterectomy and anastrozole treatment. Higher awareness of BML cases and their molecular endocrinological features in the neurosurgical community may pave to develop better strategies for treatment of these tumors causing high morbidity.
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Abstract
RATIONALE Pulmonary benign metastasizing leiomyoma (PBML) is rare, usually occurs in women who underwent hysterectomy during the reproductive years, and has no obvious clinical symptoms. A full understanding of the characteristics of PBML is important for its sequential treatment and prognosis. PATIENT CONCERNS In this report, a 36-year-old female patient with previous uterine leiomyoma who underwent 3 surgical resections of the uterus, bilateral fallopian tubes, and partial omentum was investigated. The physical examination revealed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. DIAGNOSES Chest computed tomography (CT) confirmed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. Further positron-emission tomography computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) of the whole body showed mildly intense accumulation of 18F-FDG in the tumor (maximum standardized uptake value [SUV max], 2.6). A pathological examination then confirmed the presence of fibrous and vascular tissue after CT-guided percutaneous biopsy of the tumor in the right lower lobe. Additionally, surgical resection of the tumor and nodule was performed for histological analysis and immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR). INTERVENTIONS The patient underwent complete tumor surgical resection and nodule wedge resection. OUTCOMES No postoperative complications occurred. No recurrence or other signs of metastasis were found during an 18-month follow-up observation period. CONCLUSION In this case, lung and mediastinal metastasis of uterine fibroids was observed. However, depending on only a postoperative histological analysis is insufficient for the diagnosis of PBML. Histological analysis combined with an evaluation of the expression levels of ER and PR is crucial for the diagnosis and treatment of PBML.
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Affiliation(s)
| | | | | | - Yuwei Guo
- Department of pathology, Hebei Medical University Fourth Hospital
| | - Mengdi Cong
- Department of pathology, Children's hospital of Hebei Province, Shijiazhuang, China
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9
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Yuan X, Sun Y, Jin Y, Xu L, Dai H, Wang J, Zhang Z, Chen X. Multiple organ benign metastasizing leiomyoma: A case report and literature review. J Obstet Gynaecol Res 2019; 45:2132-2136. [PMID: 31381225 DOI: 10.1111/jog.14066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Xiong Yuan
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Ying Sun
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Yichao Jin
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Lei Xu
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Huihua Dai
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Jun Wang
- Department of Radiologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Zhihong Zhang
- Department of Pathologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xing Chen
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
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10
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Abstract
Extra-uterine leiomyomatosis is a rare pathology defined by the presence of benign smooth uterine muscle cells in unusual localizations, including different entities. It mainly affects premenopausal women with a medical history of uterine myoma with or without surgical treatment. Three main types are discribed: intraveinous leiomyomatosis, benign metastatisizing leiomyoma and leiomyomatosis peritonealis disseminata. The diagnosis may be complex with many differential diagnosis, and relies on histology. The treatment depends on multiple factors such as age, localization, size, symptoms and associated comorbidities. It is based on surgical resection and hormonal privation, surgical (adnexectomy) or medical (hormonotherapy). There is a high risk of recurrence. Some malignant evolutions have been reported, mostly leiomyosarcoma following peritoneal disseminated leiomyomatosis. Long term follow-up of these patients is mandatory. A particular manifestation of extra-uterine leiomyomatosis is the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. It is an autosomal dominant disorder which confers an increased risk of cutaneous and uterine leiomyomas and renal cell cancer, with a poor prognosis due to the urologic tumor.
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Affiliation(s)
- E Declas
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France.
| | - J P Lucot
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France
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11
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Ofori K, Fernandes H, Cummings M, Colby T, Saqi A. Benign metastasizing leiomyoma presenting with miliary pattern and fatal outcome: Case report with molecular analysis & review of the literature. Respir Med Case Rep 2019; 27:100831. [PMID: 30989050 PMCID: PMC6446132 DOI: 10.1016/j.rmcr.2019.100831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare benign smooth muscle neoplasm that originates in the uterus and metastasizes to distant sites—most commonly the lungs. BMLs are often found incidentally in patients with a history of uterine leiomyoma(s) and tend to be indolent. Occasionally they may be symptomatic and rarely follow an aggressive clinical course. We report an unusual case of BML presenting in a 46-year-old woman as a miliary nodular pattern bilaterally in the lungs and progressive respiratory failure. Her past medical history was significant for uterine “leiomyomas” of at least 9 years' duration. Post mortem histologic evaluation of the uterine and lung lesions revealed benign smooth muscle neoplasms (leiomyomas and BMLs, respectively), and molecular analyses demonstrated identical clonal MED12 mutation, though with greater mutant allelic frequency in the uterus. We document a rare aggressive clinical course in a patient with BML, which presented as a miliary radiologic pattern mimicking an infectious etiology or interstitial lung disease.
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Affiliation(s)
- Kenneth Ofori
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Helen Fernandes
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Matthew Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia, University Medical Center, New York, USA
| | | | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
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12
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Ahvenainen TV, Mäkinen NM, von Nandelstadh P, Vahteristo MEA, Pasanen AM, Bützow RC, Vahteristo PM. Loss of ATRX/DAXX expression and alternative lengthening of telomeres in uterine leiomyomas. Cancer 2018; 124:4650-4656. [PMID: 30423196 DOI: 10.1002/cncr.31754] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Uterine leiomyomas (ULs) are the most common gynecologic tumors and affect 3 of every 4 women by the age of 50 years. The majority of ULs are classified as conventional tumors, whereas 10% represent various histopathological subtypes with features that mimic malignancy. These subtypes include cellular and mitotically active ULs and ULs with bizarre nuclei. Uterine leiomyosarcoma (ULMS), the malignant counterpart of UL, is an aggressive cancer with poor overall survival. The early diagnosis and preoperative differentiation of ULMS from UL are often challenging because their symptoms and morphology resemble one another. Recent studies have shown frequent loss of alpha-thalassemia/mental retardation syndrome X-linked (ATRX) or death domain-associated protein (DAXX) expression in ULMS, and this is often associated with an alternative lengthening of telomeres (ALT) phenotype. METHODS To investigate ATRX and DAXX expression and the presence of ALT in UL subtypes, immunohistochemical and telomere-specific fluorescence in situ hybridization analyses were performed. The study material consisted of 142 formalin-fixed, paraffin-embedded tissue samples representing various UL subtypes and 64 conventional ULs. RESULTS A loss of ATRX or DAXX and/or ALT was detected in 6.3% of the histopathological UL subtype samples (9 of 142). Two patients whose ULs showed either ATRX loss or ALT were later diagnosed with a pulmonary smooth muscle tumor. Pulmonary tumors displayed molecular alterations found in the corresponding uterine tumors, which indicated metastasis to the lungs. All conventional ULs displayed normal ATRX, DAXX, and telomeres. CONCLUSIONS These results highlight the differences between conventional and histopathologically atypical ULs and indicate that some UL subtype tumors may harbor long-term malignant potential.
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Affiliation(s)
- Terhi V Ahvenainen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Netta M Mäkinen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Pernilla von Nandelstadh
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Maija E A Vahteristo
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Annukka M Pasanen
- Department of Pathology, Laboratory of Helsinki University Central Hospital, Helsinki University Central Hospital and Medicum, University of Helsinki, Helsinki, Finland
| | - Ralf C Bützow
- Department of Pathology, Laboratory of Helsinki University Central Hospital, Helsinki University Central Hospital and Medicum, University of Helsinki, Helsinki, Finland
| | - Pia M Vahteristo
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
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