Figure 1
Benign metastasic leiomyomatosis: A rare case with bone affection
SectionMusculoskeletal system
Case TypeClinical Cases
Authors
María Elena Orihuela de la Cal, Carlos Alberto Machado Orihuela
Connected authors
50 years, female
Clinical History
A 50-year-old female was admitted for management and conduct of incidental cervical mass with suspected diagnosis of nerve sheath tumour. Surgery was performed, with histologic results of leiomyomatosis lineage. Studies before surgery were performed in another centre.
Imaging Findings
Post-surgical cervical CT confirmed a residual mass at the level of C3 to C5 and blastic lesions.
Body CT revealed the presence of small isolated lung nodules. Solid masses in the peritoneal cavity and in the abdominal wall, with heterogeneous attenuation. Many blastic lesions were seen in the vertebral bodies, ribs and pelvis, suggested of metastasis as the first diagnosis.
Spine MR showed many lesions with contrast enhancement, some of them with soft tissue component that affected the right foramen of D5 and D12.
Bone scintigraphy showed no “hot spots” suggestive of metastasis, considering the study results to be indeterminate.
A biopsy of the abdominal wall mass was performed with histological results compatible with leiomyoma, with positive estrogen and progesterone receptors.
Bone biopsy of the pelvis lesion was also performed, with histological results of focal infiltration by mesenchymal neoplasia with an immunoprotib compatible with leiomyomatous lineage.
Discussion
Benign metastasic leiomyomatosis (BML), is a rare entity, characterized by proliferation of smooth muscle fibre in remote places from the uterus. Bone affection is very rare, being the lung the most frequent place of appearance. Frequently presents with a radiological appearance similar to metastasic disease. The basic pathogenesis is a multicentric metaplasic change of the mesothelial connective tissue, due to an abnormal response to ovarian hormonal simulation.
Most cases are asymptomatic and are discovered incidentally in image studies. History of hysterectomy for uterine leiomyomas can guide the diagnosis.
Ultrasound, CT and MR imaging features are useful to identify and stage the disease. It can be presented as solid and complex soft tissue masses in the peritoneum cavity, with heterogeneous enhancement. It´s not associated with infiltration of omentum, ascites or liver metástasis. The diagnosis can be confirmed by biopsy, high levels of positive estrogen and progesterone receptors can also be found.
Recurrence is possible and with each one, is more likely to produce sarcomatous degeneration, although is uncommon. Prognosis is good in postmenopausal patients, although it is variable. Cases of progression have been described and are usually related to high levels of estrogen.
Written informed patient consent for publication has been obtained.
Differential Diagnosis List
Benign Metastasic Leiomyomatosis
Malignant tumour metastasis
Final Diagnosis
Benign Metastasic Leiomyomatosis
References
[1] Wei H, Liu Y, Sun H, Qian F, Li G (2013) Benign pelvis metastasic leiomyoma: case report. Clin Exp Obstet Gynecol 40(1):165-7. PMID: 23724537
[2] Fasih N, Prasad Shanbhogue AK, Macdonald DB, Fraser-Hill MA, Papadatos D, Kielar AZ, Doherty GP, Walsh C, McInnes M, Atri M (2008) Leiomyomas beyond the uterus: unusual locations, rare manifestations. Radiographics 28(7):1931-48. doi: 10.1148/rg.287085095. PMID: 19001649
[3] Goyle KK, Moore DF Jr, Garrett C, Goyle V (2003) Benign metastasizing leiomyomatosis: case report and review. Am J Clin Oncol 26(5):473-6. doi: 10.1097/01.coc.0000037737.78080.E3. PMID: 14528073
Case information
| URL: | https://eurorad.org/case/18058 |
| DOI: | 10.35100/eurorad/case.18058 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Axial lung CT showing small lung nodules (arrows)
Axial abdominal CT showing an intra-abdominal heterogeneous mass (arrow) with enhancement in the right side of the pelvis
Axial abdominal CT showing a nodule in the abdominal wall (arrow) with heterogeneous enhancement
US of the same lesion, showing hypoechoic pattern with internal small anechoic areas
Axial head CT showing a soft tissue nodule (arrow) with enhancement
Sagittal lumbar spine CT with bone filter reconstruction showing multiple blastic lesions in vertebral bodies
Axial pelvic CT with bone filter showing multiple blastic lesions in both iliac bones
Figure 3
Axial T2w cervical spine MR showing a lesion (arrow) with intermediate signal in the right foramen of C3-C5.
Sagittal T1 FAT-SAT lumbar spine MR without contrast showed multiple low and intermediate signal lesions in the vertebral bodies. The pelvic mass is partially included.
Sagittal T1 FAT-SAT lumbar spine MR with contrast showed heterogeneous enhancement of the lesions. The pelvic mass is partially included.
Figure 4
Bone scintigraphy showing no “hot spots” suggestive of metastasis.
Axial cervical spine CT showing a mass in the right foramen of C3-C5 level (arrow).
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Sagittal cervical spine CT reconstruction with bone filter showing post-surgical changes and blastic lesion in D2 body (arrow).
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Axial lung CT showing small lung nodules (arrows)
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Axial abdominal CT showing an intra-abdominal heterogeneous mass (arrow) with enhancement in the right side of the pelvis
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Axial abdominal CT showing a nodule in the abdominal wall (arrow) with heterogeneous enhancement
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
US of the same lesion, showing hypoechoic pattern with internal small anechoic areas
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Axial head CT showing a soft tissue nodule (arrow) with enhancement
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Sagittal lumbar spine CT with bone filter reconstruction showing multiple blastic lesions in vertebral bodies
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Axial pelvic CT with bone filter showing multiple blastic lesions in both iliac bones
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Axial T2w cervical spine MR showing a lesion (arrow) with intermediate signal in the right foramen of C3-C5.
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Sagittal T1 FAT-SAT lumbar spine MR without contrast showed multiple low and intermediate signal lesions in the vertebral bodies. The pelvic mass is partially included.
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Sagittal T1 FAT-SAT lumbar spine MR with contrast showed heterogeneous enhancement of the lesions. The pelvic mass is partially included.
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Bone scintigraphy showing no “hot spots” suggestive of metastasis.
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain
Department of Radiology, CHUIMI, Las Palmas de Gran Canaria, Spain