1 Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China ; 2 Department of Internal Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing 210029, China.
J Thorac Dis. 2014 Jun;6(6):E92-8. doi: 10.3978/j.issn.2072-1439.2014.04.37.
Benign metastasizing leiomyoma (BML) is a rare condition that occurs in all age groups and that is particularly prevalent among women of late childbearing age. All patients have a history of uterine leiomyoma and/or myomectomy, often associated with distant metastases from the uterus, which commonly occurs in the lung. We report the case of a 32-year-old young woman suffering from chest stuffiness, labored respiration and weakness after a myomectomy performed one month earlier. The chest CT showed a diffuse miliary shadow in both sides of her lungs, but serum tumor markers such as CA125, CA199, carcinoembryonic antigen (CEA), neuron specific enolase (NSE), and CYFRA21-1 were normal. The patient underwent a lung biopsy by thoracoscopic surgery after four weeks of anti-TB treatment; there were no significant changes in the chest CT. H&E staining showed that the tumor cells had characteristics of smooth muscle cell differentiation. Immunohistochemical staining showed a low tumor cell proliferation index, which indicated that the likelihood of a malignancy was not high. There was no expression of CD10, indicating a diagnosis of pulmonary benign metastasizing leiomyoma (PBML). Smooth muscle actin (SMA) and desmin as specific markers of smooth muscle and the estrogen receptor (ER) and progesterone receptor (PR) were all strongly positive, which is characteristic of PBML. The patient was given the anti-estrogen tamoxifen for 3 months. With no radiological evidence of disease development and further distant metastasis, the patient will continue to be followed.
良性转移性平滑肌瘤（BML）是一种罕见的疾病，可发生于所有年龄段，尤其多见于晚育年龄的妇女。所有患者均有子宫肌瘤和/或子宫肌瘤切除术病史，常有子宫远处转移，常见于肺部。我们报告了一例 32 岁年轻女性，在 1 个月前接受子宫肌瘤切除术一个月后出现胸闷、呼吸困难和乏力。胸部 CT 显示双肺弥漫性粟粒状阴影，但血清肿瘤标志物如 CA125、CA199、癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）和细胞角蛋白 19 片段 21-1 均正常。在抗结核治疗 4 周后，患者接受了胸腔镜下肺活检；胸部 CT 无明显变化。H&E 染色显示肿瘤细胞具有平滑肌细胞分化的特征。免疫组化染色显示肿瘤细胞增殖指数低，提示恶性可能性不大。CD10 无表达，提示诊断为肺良性转移性平滑肌瘤（PBML）。平滑肌肌动蛋白（SMA）和结蛋白作为平滑肌的特异性标志物，雌激素受体（ER）和孕激素受体（PR）均呈强阳性，这是 PBML 的特征。给予患者抗雌激素他莫昔芬治疗 3 个月。无疾病进展和进一步远处转移的影像学证据，患者将继续随访。
