A Case Report Of Pulmonary Benign Metastasizing Leiomyoma And Literature Review

Objective:Analyze the clinical features,diagnosis and therapy of a case of pulmonary benign metastasizing leiomyoma(PBML)and summarize the experience of diagnosis and therapy,to improve the strategy of the diagnosis and therapy of PBML,cause the attention of clinician.Method:Retrospectively analysis on one patient who was diagnosed with pulmonary benign metastasizing leiomyoma(PBML)at the first affiliated hospital of Guangxi Medical University in 2014,analyze its clinical manifestation,pulmonary function,radiological features diagnosis and therapy,explore its clinical features and possible mechanism with literatures rivew.Results:(1)General information:middle-aged female patient,44 years old,farmer;(2)clinical manifestations:the patient presented with shortness of breath and cyanosis.She had a history of subtotal hysterectomy for uterine fibroids in 2008.Oral,limb-skin cyanosis,both lungs can sound Velcro rale,the right forea-rm can hit a nodule;(3)Laboratory examination:her sex hormones were abnor-mal and arterial blood gas analysis showed hypoxemia;(4)imaging examinati-on:the chest CT revealed showed diffuse shadow in both lungs;(5)Pulmonary function:mild restrictive ventilatory dysfunction and moderate diffuse dysfunc-tion;(6)Histopathology:the TBLB suggested visible in the lung tissue hyperpl-asia of spindle cells,form the size of nodular lesions,the immunohistochemical of spindle cells expression SMA(+),ER(+),PR(+),combined with clinical,the patient was considered for pulmonary benign leiomyoma;(7)Merge in patient with cerebral white matter demyelination,nodular vasculitis and striated muscle atrophy degenerative changes;(8)Treatment:the patient was treated with tripto-relin and hormone,her symptoms improved.Compared with before,the chest CT prompted that the two lung diseases were absorbed.Conclusion:(1)The main features of the patient were that she had a history of uterine fibroids,shortness of breath,chest CT revealed showed multiple nodular lesions,lung tissue pathology examination showed a large number of smooth muscle cell proliferation,the immunohistochemical of the tumor cells express ER(+),PR(+),in addition,the patient has systemic lesions,anti-progestogen and prednisone therapy are effective;(2)With literature review,the disease is chronic onset and rare,often occurs in women of childbearing age,The severity of clinical symptoms are not conformed to the lung lesions,most of the pulmonary lesions expression of ER,PR,it is necessary to identify the lung primary leiomyoma and so on,surgery and anti-progestogen therapy are the main treatment methods;(3)Its possible mechanism may be that abnormal hormone,autoimmune disorder lead to many parts of the smooth muscle hyperplasia or the pulmonary smooth muscle with ectopic hyperplasia.