Aberrant uterine leiomyomas with extrauterine manifestation: intravenous leiomyomatosis and benign metastasizing leiomyomas.
10.5468/ogs.2018.61.4.509
- Author:
Yoo Na KIM
1
;
Kyung Jin EOH
;
Jung Yun LEE
;
Eun Ji NAM
;
Sunghoon KIM
;
Sang Wun KIM
;
Young Tae KIM
Author Information
1. Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea. ytkchoi@yuhs.ac
- Publication Type:Original Article
- Keywords:
Leiomyoma, uterine;
Smooth muscle tumor;
Leiomyomatosis;
Neoplasm metastasis
- MeSH:
Blood Platelets;
Diagnosis;
Follow-Up Studies;
Hemorrhage;
Humans;
Inflammation;
Leiomyoma*;
Leiomyomatosis*;
Leukocytes;
Myoma;
Neoplasm Metastasis;
Neutrophils;
Pathology, Surgical;
Recurrence;
Reference Values;
Smooth Muscle Tumor;
Thorax
- From:Obstetrics & Gynecology Science
2018;61(4):509-519
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Intravenous leiomyomatosis (IVL) and benign metastasizing leiomyoma (BML) are uncommon variants of benign uterine leiomyomas with extrauterine manifestations. Categorizing the extent of disease allows clinicians to delineate the clinical spectrum and the level of sophistication for complete surgical resection. METHODS: Twelve patients with IVL and BML were reviewed. They were divided into early versus late stage disease groups, and initial manifestation, clinical characteristics, laboratory values, surgical pathology, and follow up data were summarized. RESULTS: Patients were mostly pre- or peri-menopausal and parous. Patients with late stage disease were more likely to present with cardiac symptoms or abnormal findings on chest X-ray, whereas those with early stage disease presented with classical leiomyoma symptoms including heavy menstrual bleeding, increased myoma size, or lower abdominal discomfort. Tumor marker levels were within normal ranges. A trend of higher neutrophil to leukocyte ratio was observed in the late versus the early stage group (10.4 vs. 1.51, P=0.07); the platelet leukocyte ratio was statistically higher in patients with late stage IVL (0.23 vs. 0.13, P=0.04). The overall recurrence rate was 25%. No recurrence was observed in stage I or stage III IVL groups, while 50% of the stage II IVL group showed recurrence in the pelvic cavity. CONCLUSION: IVL and BML are benign myoma variants with paradoxically metastatic clinical presentation. Careful inquiry of systemic symptoms, the presence of underlying systemic inflammation, and a high index of suspicion are required for preoperative diagnosis. Furthermore, a multidisciplinary approach is necessary to improve outcomes of surgical resection.