Consamus Erin N, Reardon Michael J, Ayala Alberto G, Schwartz Mary R, Ro Jae Y
Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College of Cornell University, New York, New York.
Methodist Debakey Cardiovasc J. 2014 Oct-Dec;10(4):251-4. doi: 10.14797/mdcj-10-4-251.
Cardiac smooth muscle tumors are rare. Three different clinical settings for these tumors have been reported, including benign metastasizing leiomyoma from the uterus, primary cardiac leiomyoma and leiomyosarcoma, and intravenous cardiac extension of pelvic leiomyoma, which is the most common. We present a case of a 55-year-old woman with a benign metastasizing leiomyoma to the heart 17 years after hysterectomy and 16 years after metastasis to the lung. Immunohistochemical stains for smooth muscle actin, desmin, and estrogen and progesterone receptors were positive, indicating a smooth muscle tumor of uterine origin. To our knowledge, this is only the fourth reported case of benign metastasizing leiomyoma to the heart and the first case of long-delayed cardiac metastasis after successful treatment of pulmonary metastasis. It illustrates that benign metastasizing leiomyoma should be included in the differential diagnosis of cardiac tumors in patients with a history of uterine leiomyoma, especially when associated with pulmonary metastasis.
心脏平滑肌肿瘤较为罕见。已报道了这些肿瘤的三种不同临床情况，包括子宫良性转移性平滑肌瘤、原发性心脏平滑肌瘤和平滑肌肉瘤，以及盆腔平滑肌瘤向心脏的静脉内延伸，后者最为常见。我们报告一例55岁女性，在子宫切除术后17年、肺转移后16年发生心脏良性转移性平滑肌瘤。平滑肌肌动蛋白、结蛋白以及雌激素和孕激素受体的免疫组化染色均为阳性，表明为子宫起源的平滑肌瘤。据我们所知，这是第四例报道的心脏良性转移性平滑肌瘤病例，也是成功治疗肺转移后出现长期延迟心脏转移的首例病例。这表明，对于有子宫平滑肌瘤病史的患者，尤其是伴有肺转移时，心脏肿瘤的鉴别诊断应包括良性转移性平滑肌瘤。
