Intravenous leiomyomatosis of the uterus with pulmonary metastases or a case with benign metastasizing leiomyoma?

BACKGROUND Intravenous leiomyomatosis (IVL) is defined as an intraluminal growth of benign smooth muscle cells in either venous or lymphatic vessels outside the confines or even in the absence of leiomyomas. Benign metastasizing uterine leiomyoma is defined as a histologically benign uterine smooth muscle tumor that acts in a somewhat malignant fashion and produces benign metastases. We report a case of a patient suffering from IVL of the uterus and pulmonary leiomyomatosis. CASE REPORT The patient presented with severe hypermenorrhoe and a rapidly growing uterine fibroid. She underwent laparatomy with total abdominal hysterectomy. The nodules were classified as endovascular leiomyomatosis. Postoperatively, the patient developed a pulmonary embolism and additionally diffuse, multiple nodules of the lungs were detected in the lung scan. An open lung biopsy led to the diagnosis of pulmonary leiomyomatosis. The patient was put on a regimen of gonadotropin-releasing hormone for a total of 6 months and a lung scan after 6 months revealed stable disease. CONCLUSION Though intravenous leiomyomatosis imitates a malignant neoplasm concerning the pattern of growth and extension, and benign metastasizing leiomyoma produces benign metastases, they must be differentiated histologically from malignant tumors to prevent overtreatment.