Uterine Leiomyoma Metastatic to the Lung

Introduction: Uterine leiomyomas belong to a heterogeneous family of tumors with peculiar biological behaviour. Pulmonary metastases may originate from frankly malignant leiomyomas (sarcomas) as well as from so called benign metastasizing leiomyomas. Latency between hysterectomy and metastatic disease may vary from few months to several years. We report two cases with an exceptionally long latent period. Methods: Two cases of apparently primary giant lung tumor were observed. Both presenting clinical history of fever and malaise. Chest x-ray showed in both cases a left pulmonary opacity. Preoperative work-up yielded the diagnosis respectively of epithelial and mesenchymal tumor without extrapulmonary localization (CT and PET-CT). Results: Case N 1: 68 year-old (Z.A.), the giant lobulated tumor, invading the hilar structures, required a left pneumonectomy. Histology revealed a metastatic uterine leiomyoma. She had under- gone hysterectomy for multiple leiomyomas 21 years previously. Case N 2: 66 year-old (M.M), was submitted to left pneumonectomy for a giant tumor extended to both lobes. Also in this case metastasis from uterine leiomyoma was diagnosed and confirmed by comparison with histology from hysterectomy (performed 16 years previously). There was no peri-operative mortality. Both the patients are alive without evidence of disease 6 and 3 months after surgery. Discussion: These cases suggest that the diagnosis of primary pulmonary sarcoma needs careful pathological assessment and follow-up of the patients submitted to hysterectomy for leiomyoma should be protracted.