Rokas Kurtinaitis1, Kamilė Počepavičiūtė1, Dovilė Barakauskaitė1, Ieva Keturkaitė1, Laima Dobrovolskienė1, Algidas Basevičius1
1Department of Radiology of Lithuanian University of Health Sciences Kaunas, Lithuania.
Background and aim: Pulmonary leiomyomatosis (PBML) is the most common type of metastasizing leiomyomas. It is routinely found by a chest X-ray in women with a medical record of myomectomy related to uterine leiomyoma. These findings in young women are frequently misinterpreted as metastasized lung cancer due to the similarity of radiological findings. This article aims to describe a clinical case, define the diagnostic value of radiological imaging findings and to differentiate the distant leiomyoma metastases from malignant ones.
Material and methods: We present a new case of PBML post hysterectomy mimicking malignant pulmonary metastases. Additionally, a literature review was conducted for case reports and previous literature reviews describing PBML, its etiology, pathogenesis, and diagnostic features. Medline (PubMed), ScienceDirect, Hindawi, EPOSTM databases were used.
Results: PBML nodules pose a diagnostic ambiguity by mimicking malignant pulmonary metastases especially on routine chest X-rays and CT scans. Our presented case is similar to previously reported cases, and MRI played a crucial role in the differential diagnosis. In 10 of 13 investigated cases, nodules were multiple and bilateral, oval in shape and well-circumscribed. The average age of patients described in the reviewed case reports was 47,2 years. 77 % of them have had a history of leiomyoma and hysterectomy or myomectomy.
Conclusion: Although PBML is a rare condition it should be considered for patients with a history of leiomyoma or hysterectomy or myomectomy due to leiomyomatosis. It is essential seeing as these findings are often misdiagnosed as malignancy because of ambiguous radiological findings, such as bilateral and multifocal well-circumscribed rounded lesions that vary in size. MRI is a suitable tool for evaluating these nodules and ADC value can be useful to differentiate benign nodules from malignant metastasis.
Keywords: pulmonary leiomyomatosis, benign metastasizing leiomyoma, computed tomography.