Grcevich Leah O, O'Connell Alexis, Jabaay Maxwell J, Scott Jonathan T
Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA.
Obstetrics and Gynecology, Women's Medical Center, Dothan, USA.
Cureus. 2021 Sep 25;13(9):e18274. doi: 10.7759/cureus.18274. eCollection 2021 Sep.
Uterine leiomyomas (LM) are tumors arising from the non-neoplastic proliferation of smooth muscle cells within the myometrium. Like benign tumors, LM are not generally spread through the lymphatic system, and therefore should not be associated with lymphadenopathy. Herein, we present a case of a 60-year-old female who presented to the clinic with postmenopausal bleeding in the setting of sonographically evident uterine LM and abdominal lymphadenopathy. A lymph node biopsy revealed plasma cells and an eosinophilic material presumptively diagnosed as amyloid. She then underwent an abdominal hysterectomy for definitive treatment of LM. Surgical pathology confirmed the clinical diagnosis of uterine and cervical leiomyoma. Current literature suggests that genetic and epigenetic abnormalities contribute to the pathogenesis of LM in addition to hormonal signals such as estrogen and progesterone. It is unusual for LM to occur in post-menopausal women due to reduced hormonal influence. Therefore, this case explored an alternative mechanism of tumor proliferation. This case hypothesizes that genetic mutations and epigenetic changes resulting from chronic inflammatory offenses contributed to LM growth and lymphadenopathy.
子宫平滑肌瘤（LM）是由子宫肌层内平滑肌细胞的非肿瘤性增殖形成的肿瘤。与良性肿瘤一样，LM通常不会通过淋巴系统扩散，因此不应伴有淋巴结病。在此，我们报告一例60岁女性病例，该患者因绝经后出血就诊，超声检查显示子宫有LM且伴有腹部淋巴结病。淋巴结活检发现浆细胞和一种嗜酸性物质，初步诊断为淀粉样蛋白。随后她接受了腹部子宫切除术以明确治疗LM。手术病理证实了子宫和宫颈平滑肌瘤的临床诊断。目前的文献表明，除了雌激素和孕激素等激素信号外，基因和表观遗传异常也有助于LM的发病机制。由于激素影响减弱，LM在绝经后女性中很少见。因此，本病例探讨了肿瘤增殖的另一种机制。本病例推测，慢性炎症侵袭导致的基因突变和表观遗传变化促成了LM的生长和淋巴结病。
