Journal of Cytology
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 25  |  Issue : 3  |  Page : 105-107
Fine needle aspiration diagnosis of a benign metastasizing leiomyoma of the abdominal wall


1 Faculty of Medicine, Kuwait University; Cytology Laboratory, Mubarak Al-Kabeer Hospital, Kuwait
2 Cytology Laboratory, Mubarak Al-Kabeer Hospital, Kuwait
3 Histopathology Laboratory, Hussain Makki Al-Juma Center for Specialized Surgery, Kuwait
4 Faculty of Medicine, Kuwait University; Radiology Department, Chest Hospital, Kuwait

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   Abstract 

We describe here the case of a 42 year-old female with a benign, metastasizing leiomyoma (BML) of the abdominal wall diagnosed by fine needle aspiration. The patient had undergone myomectomy for uterine leiomyomas eight years ago. BMLs are composed of well-differentiated smooth muscle and are uncommon tumors that are more often seen in the lungs; soft tissues and skeletal muscle are rarely involved.

Keywords: Abdominal wall; benign metastasizing leiomyoma; fine needle aspiration cytology.

How to cite this article:
Kapila K, Mallik MK, Amanguno HG, Ahmed A. Fine needle aspiration diagnosis of a benign metastasizing leiomyoma of the abdominal wall. J Cytol 2008;25:105-7

How to cite this URL:
Kapila K, Mallik MK, Amanguno HG, Ahmed A. Fine needle aspiration diagnosis of a benign metastasizing leiomyoma of the abdominal wall. J Cytol [serial online] 2008 [cited 2014 Apr 18];25:105-7. Available from: http://www.jcytol.org/text.asp?2008/25/3/105/44047



   Introduction Top


Benign metastasizing leiomyoma (BML) is an ill defined, clinicopathological condition which features "metastatic," histologically benign smooth muscle tumor deposits in the lung, lymph node, or abdomen that appear to be derived from benign uterine leiomyoma. [1],[2] The pathogenesis of this lesion is controversial. [3] Egberts et al. [1] found 87 BML cases reported in PubMed, most of which described the lung as the commonly affected extrauterine organ. Only a few cases report distant tumor sites such as the skin, soft tissues, skeletal muscle, breast, pelvis, abdomen, greater omentum, inferior vena cava, right atrium, brain, and bones. [4],[5],[6] We report here a case of BML presenting as a solitary mass in the abdominal wall, which was detected on fine needle aspiration cytology (FNAC), and later confirmed on histology.


   Case Report Top


A 42 year-old female presented with a progressively growing swelling in the left iliac fossa at the site of the previous surgery for myomectomy eight years ago. A computed tomography (CT) scan of the abdomen [Figure 1] showed an oval 1.7 x 2.2 cm mass lesion in the subcutaneous fat plane of the left iliac fossa with no invasion of the abdominal cavity by this mass. A subserosal fibroid (3.4 x 5.8 cm) was seen in the left lateral aspect of the uterine wall with a cyst (1.8 x 1.3 cm) in the left ovary. An ultrasound-guided FNA was done of the mass in the abdominal wall.

Smears from the aspirate were cellular, with small and large clusters of uniform, spindle-shaped cells with minimal pleomorphism [Figure 2] and [Figure 3]; occasional mitosis was observed. The cells stained positive for desmin and CD10. The cytologic findings were suggestive of a benign spindle cell tumor-a leiomyoma. However, in light of the occasional mitosis observed, a histological examination was recommended to rule out a low-grade leiomyosarcoma.

The subcutaneous mass was excised and a gray-tan, nodular mass measuring 4 x 2.3 x 2 cm was received for histopathological examination along with its overlying skin [Figure 4a]. Sections of the subcutaneous mass showed a circumscribed nodular area of proliferating, interlacing bundles of smooth muscle separated by fibrocollagenous stroma. There was no necrosis or atypia, and scar tissue was seen in the dermis. The excised margins were free and a histological diagnosis of leiomyoma was rendered [Figure 4b], [Figure 4c].


   Discussion Top


Most reported cases of BML have been in females aged approximately 40 years, with a history of uterine leiomyomas or their operative removal, as seen in our case. The extrauterine tumors localize, particularly in the lungs. Only a few cases report of distant tumor sites such as a the skin, soft tissue, skeletal muscle, breast, pelvis, abdomen, greater omentum, spine, brain, bones, and the heart. [4],[5],[6] Most patients are asymptomatic with lung lesions being discovered from chest radiographs taken for other reasons. In our case, diagnosis was first-made based on FNAC of the mass in the abdominal wall and the chest radiographs did not show any lesions. A review of the literature revealed a few case reports of percutaneous/guided needle aspiration of BML of the lung. [7],[8],[9] However, a definitive cytological report was rendered only by Hafiz et al . [8] To the best of our knowledge, FNA of BML from sites other than the lung have not been reported before. The clinical course of these lesions is usually chronic and benign. There is no standardized treatment for BML. [10] Reported treatment methods include careful observation, surgical resection, hysterectomy and bilateral salphingo-oopherectomy, progesterone, and medical castration using luteinising hormone-releasing hormone analogs. [10] The origin of the tumor remains controversial, initially regarded as malformative tumors, but later interpreted as hematogenous metastasis of uterine leiomyomas via pelvic venous channels to extrauterine organs. [9] Biopsy is needed to confirm the benign diagnosis and regular follow-up is required.

 
   References Top

1.Egberts JH, Schafmayer C, Bauerschlag DO, Jδnig U, Tepel J. Benign abdominal and pulmonary metastasizing leiomyoma of the uterus. Arch Gynecol Obstet 2006;274:319-22.  Back to cited text no. 1    
2.Tavassoli FA, Devilee P. WHO classification of tumours: Pathology and genetics tumors of the breast and female genital organs. Lyon: IARC Press; 2003. p. 242.  Back to cited text no. 2    
3.Patton KT, Cheng L, Papavero V, Blum MG, Yeldandi AV, Adley BP, et al . Benign metastasizing leiomyoma: Clonality, telomere length and clincopathologic analysis. Mod Pathol 2006;19:130-40.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Horiuchi K, Yabe H, Mukai M, Morioka H, Udagawa Y, Nozawa S, et al . Multiple smooth muscle tumors arising in deep soft tissues of lower limbs with uterine leiomyomas. Am J Surg Pathol 1998;22:897-901.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Jo JH, Lee JH, Kim DC, Kim SH, Kwon HC, Kim JS, et al . A case of benign metastasizing leiomyoma with multiple metastasis to the soft tissue, skeletal muscle, lung and breast. Korean J Intern Med 2006;21:199-201.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Nam MS, Jeon MJ, Kim YT, Kim JW, Park KH, Hong YS. Pelvic leiomyomatosis with intracaval and intracardiac extension: A case report and review of the literature. Gynecol Oncol 2003;89:175-80.  Back to cited text no. 6  [PUBMED]  
7.Chan JW, Law WL, Cheung SO, Lee MP, Ng CK, Lee S, et al . Benign metastasizing leiomyoma: A rare but possible cause of bilateral pulmonary nodules in Chinese patients. Hong Kong Med J 2005;11:303-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Hafiz MA, Wang KP, Berkman A. Fine needle aspiration diagnosis of benign metastasizing leiomyoma of the lung: A case report. Acta Cytol 1994;38:398-402.  Back to cited text no. 8  [PUBMED]  
9.Osadchy A, Zehavi T, Zissin R. Pulmonary benign metastasizing leiomyomas presenting as fluid-containing masses on CT in a patient with two unrelated malignancies. Br J Radiol 2005;78:639-41.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Funakoshi Y, Sawabata N, Takeda S, Hayakawa M, Okumura Y, Maeda H. Pulmonary benign metastasizing leiomyoma from the uterus in postmenopausal woman: Report of a case. Surg Today 2004;34:55-7.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Kusum Kapila
Department of Pathology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110
Kuwait
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DOI: 10.4103/0970-9371.44047

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4a], [Figure 4b], [Figure 4c]



 

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    Abstract
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