Benign metastasizing leiomyoma, a rare imposter of metastatic cervical cancer

Highlights

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  Differential for necrotic pelvic mass with pulmonary nodules.

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  Benign metastasizing leiomyoma in woman with limited surgical history.

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  Efficacy of estrogen depletion therapy for benign metastasizing leiomyoma.

Abstract

Benign metastasizing leiomyoma (BML) is a rare variant of common benign smooth muscle neoplasm. We report a case of BML in a 45-year-old premenopausal woman with a significant smoking history and no previous history of cervical cancer screening. The patient presented with vaginal bleeding, abdominal pain, a necrotic mass in the vagina, and an incidental finding of diffuse pulmonary nodules on chest imaging. A total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) was performed for symptomatic management and adequate tissue sampling followed by fine needle biopsy of a pulmonary lesion. The pedunculated uterine mass and the pulmonary nodule were both consistent with smooth muscle neoplasm suggestive of myoma. Six-months following surgery, the patient is asymptomatic with partial regression of her lung nodules and no evidence of new or enlarging lesions while on treatment with Megestrol.