Pulmonary benign metastasizing leiomyoma: clinical and therapeutic analyses of 11 patients treated at a single institution

Pulmonary benign metastasizing leiomyoma (BML) occurs predominantly in women of reproductive age and usually develops several years after the resection of uterine leiomyoma. There is no standardized treatment for pulmonary BML owing to its low incidence. In this study, we retrospectively analyzed 11 patients with pulmonary BML. Major symptoms, imaging findings, therapeutic modalities, and outcomes were analyzed. The median patient age was 51 years (range, 45-65 years). All patients had uterine leiomyoma, for which all but one patient received myomectomy or hysterectomy. The preoperative symptoms included chest pain and coughing in four (36.4%) patients. In eight (72.7%) patients, computed tomography can revealed bilateral, multiple pulmonary nodules. The interval between the surgery for uterine leiomyoma and the diagnosis of pulmonary BML ranged from 13 months to 19 years. Thoracoscopic wedge resection was performed for two patients with unilateral pulmonary tumors. Therapeutic modalities included bilateral salpingo-oophorectomy, gonadotropin-releasing hormone agonist, aromatase inhibitor, progestin, and tamoxifen. All but one patient is alive to date; the patient who received no treatment died of respiratory failure due to rapid progression of pulmonary BML. Our data for an unselected group of patients with pulmonary BML treated at a single institution are consistent with results from previous studies indicating that pulmonary BML is best managed with metastasectomy and/or a combination of surgery and hormonal therapy.