초록접수 현황
| 14F-139 | 포스터 발표 |
Transformation to Leiomyosarcoma from Benign Metastasizing Pulmonary Leiomyoma - A Case Report
금동윤¹, 송경섭¹, 김재범¹, 박창권¹, 황일선²
계명대학교 의과대학 흉부외과학교실¹, 계명대학교병원 병리학교실²
Background : Benign metastatic pulmonary leiomyoma(MPL), was reported initially in 1937. That is a very rare disease that has been reported about 100 cases. Also malignant transformation of MPL is extremely rare. Here we introduce one case of leiomyosarcoma of pleura who was diagnosed as benign MPL.
Methods : CASE
June 2014, 61 year-old female was admitted with history of severe dry coughing. Chest CT revealed 95mm sized huge mass on right lower lobe compressing the bronchus to lower lobe. 9 years ago, She had undergone hysterectomy and pathologic diagnosis was leiomyoma. After 2 years later from hysterectomy, on chest CT, there were multiple nodules on both lung and were diagnosed as benign MPL by needle biopsy, originated from uterine leiomyoma. But there was no symptom, no further managements were made at that time. June 2014, the pathologic result of CT-guided needle biopsy on right lower lobe lung mass was leiomyoma. Right lower lobectomy was planned to resolve her symptom. After right thoracotomy, 100mm sized huge multiple lobulated and partially cystic changed mass was observed. That mass was originated from visceral pleura. Also, fine multiple whitish nodules were found on diaphragm, parietal and visceral pleura. Mass excision was done and she was discharged 8 days after operation without complication. Interestingly, pathologic findings of mass was leiomyosarcoma involving visceral pleura. The tumor replacing lung parenchyme was composed of partial leiomyoma and broad necrosis lesion that showed highly cellular atypia and frequent mitoses. On PET-CT, both lung multiple metastasis and paraaortic, supraclavicular lymph node metastasis were observed.
Conclusion : Early mass resection is point of treatment of leiomyosarcoma, because metastasis of leiomyosaroma is slow and prognosis of metastatic leiomyosarcoma is poor. Diagnosis of leiomyosarcoma is difficult through needle biopsy, because leiomyosarcoma usually coexists with leiomyoma. But preventive resection or diagnostic resectional biopsy of MPL is not recommended, because benign MPL is rare and malignant change of it is extremely rare. Therefore, regular observation is necessary in MPL patients and, if there is new developing lung mass or rapid size change, diagnostic mass resection should be done.
Methods : CASE
June 2014, 61 year-old female was admitted with history of severe dry coughing. Chest CT revealed 95mm sized huge mass on right lower lobe compressing the bronchus to lower lobe. 9 years ago, She had undergone hysterectomy and pathologic diagnosis was leiomyoma. After 2 years later from hysterectomy, on chest CT, there were multiple nodules on both lung and were diagnosed as benign MPL by needle biopsy, originated from uterine leiomyoma. But there was no symptom, no further managements were made at that time. June 2014, the pathologic result of CT-guided needle biopsy on right lower lobe lung mass was leiomyoma. Right lower lobectomy was planned to resolve her symptom. After right thoracotomy, 100mm sized huge multiple lobulated and partially cystic changed mass was observed. That mass was originated from visceral pleura. Also, fine multiple whitish nodules were found on diaphragm, parietal and visceral pleura. Mass excision was done and she was discharged 8 days after operation without complication. Interestingly, pathologic findings of mass was leiomyosarcoma involving visceral pleura. The tumor replacing lung parenchyme was composed of partial leiomyoma and broad necrosis lesion that showed highly cellular atypia and frequent mitoses. On PET-CT, both lung multiple metastasis and paraaortic, supraclavicular lymph node metastasis were observed.
Conclusion : Early mass resection is point of treatment of leiomyosarcoma, because metastasis of leiomyosaroma is slow and prognosis of metastatic leiomyosarcoma is poor. Diagnosis of leiomyosarcoma is difficult through needle biopsy, because leiomyosarcoma usually coexists with leiomyoma. But preventive resection or diagnostic resectional biopsy of MPL is not recommended, because benign MPL is rare and malignant change of it is extremely rare. Therefore, regular observation is necessary in MPL patients and, if there is new developing lung mass or rapid size change, diagnostic mass resection should be done.
책임저자: 금동윤
계명대학교 의과대학 흉부외과학교실
연락처 : 송경섭, Tel: 053-250-7307 , E-mail : chest.songks@gmail.com
