Arif S, Ganesan R, Spooner D
Department of Oncology, Queen Elizabeth Hospital, Metchley Lane, Edgbaston, Birmingham B15 2TH, UK.
Int J Gynecol Cancer. 2006 May-Jun;16(3):1448-50. doi: 10.1111/j.1525-1438.2006.00607.x.
Benign metastasizing leiomyoma (BML) and intravascular leiomyomatosis (IVL) are rare variants of uterine leiomyomas. In our search of available literature, there have been only two reports of these conditions occurring in the same patient. We report a case of a 42-year-old female presenting with a left L4 nerve root lesion, left paravesical lesion, left ovarian cyst, multiple pulmonary metastases, and an intracaval lesion. Histology confirmed these to be leiomyomata strongly positive for estrogen receptors. Treatment included surgery, in two stages, to remove the L4 nerve root, left paravesical lesion, intracaval lesion, and a single pulmonary nodule. The remaining tumor was treated with a gonadotrophin-releasing hormone agonist, resulting in significant reductions in tumor size. It was concluded that the lesions in the lungs were an example of BML arising from the initial diagnosis of uterine leiomyoma, and the caval lesion was an IVL. Long-term follow-up is recommended, and familiarity with rare forms of benign smooth muscle uterine tumors is essential in avoiding misdiagnosis and overtreatment.
良性转移性平滑肌瘤（BML）和血管内平滑肌瘤病（IVL）是子宫平滑肌瘤的罕见变体。在我们检索现有文献时，仅有两例关于这些病症发生在同一患者身上的报道。我们报告一例42岁女性病例，该患者表现为左侧L4神经根病变、左侧膀胱旁病变、左侧卵巢囊肿、多发肺转移瘤以及腔静脉内病变。组织学检查证实这些病变为雌激素受体强阳性的平滑肌瘤。治疗包括分两阶段进行手术，切除L4神经根、左侧膀胱旁病变、腔静脉内病变以及单个肺结节。其余肿瘤采用促性腺激素释放激素激动剂治疗，肿瘤大小显著缩小。结论是肺部病变是最初诊断为子宫平滑肌瘤后发生的BML实例，而腔静脉病变为IVL。建议进行长期随访，熟悉罕见形式的良性子宫平滑肌肿瘤对于避免误诊和过度治疗至关重要。
