14例肺良性转移性子宫平滑肌瘤影像学表现及文献回顾
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摘要
目的探究肺良性转移性子宫平滑肌瘤(PBML)的临床特点及其CT表现,为早期诊断及治疗提供依据。方法回顾性分析4例PBML病例,整理相关病例资料,结合国内外相关研究,总结该罕见病的临床及影像学特点。结果 PBML多发于肺和腹壁,肺转移CT表现为双肺多发高密度结节,大小不等,边界尚清;腹壁转移CT表现为前腹壁类圆形低密度占位,边界清晰;CT增强扫描示肿瘤内部血供丰富.行~(18)F-FDG-PET/CT可见肿块不均匀代谢增高,肺部和腹壁肿块SUVmax分别为3.6和7.1。结论影像学检查尤其CT和~(18)F-FDG-PET/CT对于诊断PBML有重要价值。
Objective To explore the clinical manifestations and imaging features of pulmonary benign metastatic leiomyoma,and provide valuable references fo early diagnosis and treatment. Methods Analyzed retrospectively the 4 cases with PBML treated in the Affiliated Hospital of Qingdao University from 2007 to 2017 and collected the relevant clinical data. Summarized the clinical manifestations and imaging features of this rare disease according to the clinical data and correlative research from home and abroad. Results The metastases most often occur in lungs and abdominal wall. The CT of lung metastases showed multiple high density nodules with different sizes and fairly clear border in both lungs; the CT manifestation of abdominal wall showed roundish low density mass with clear border in anterior abdominal wall.Enhanced CT scan showed rich blood supply in the mass. By ~(18)F-FDG-PET/CT,the nodules and mass above showed irregularly high metabolism and the SUVmax were 3.6 and 7.1 in lung and abdominal wall metastases respectively. Conclusion Imaging examinations especially CT and ~(18)F-FDG-PET/CT were valuable in the diagnosis of metastatic uterine leiomyoma.
Objective To explore the clinical manifestations and imaging features of pulmonary benign metastatic leiomyoma,and provide valuable references fo early diagnosis and treatment. Methods Analyzed retrospectively the 4 cases with PBML treated in the Affiliated Hospital of Qingdao University from 2007 to 2017 and collected the relevant clinical data. Summarized the clinical manifestations and imaging features of this rare disease according to the clinical data and correlative research from home and abroad. Results The metastases most often occur in lungs and abdominal wall. The CT of lung metastases showed multiple high density nodules with different sizes and fairly clear border in both lungs; the CT manifestation of abdominal wall showed roundish low density mass with clear border in anterior abdominal wall.Enhanced CT scan showed rich blood supply in the mass. By ~(18)F-FDG-PET/CT,the nodules and mass above showed irregularly high metabolism and the SUVmax were 3.6 and 7.1 in lung and abdominal wall metastases respectively. Conclusion Imaging examinations especially CT and ~(18)F-FDG-PET/CT were valuable in the diagnosis of metastatic uterine leiomyoma.
引文
1 Cramer SF,Patel A.The frequency of uterine leiomyomas[J].Am JClin Pathol,1990,94:435-438.
2 Taftaf R,Starnes S,Wang J,et al.Benign metastasizing leiomyoma:A rare type of lung metastases-two case reports and review of the literature[J].Case Rep Oncol Med,2014:842841,2014.
3 Egberts JH,Schafmayer C,Bauerschlag DO,et al.Benign abdominal and pulmonary metastasizing leiomyoma of the uterus[J].Arch Gynecol Obstet,2006,274:319-322.
4 Allen MS.Multiple benign lung tumors[J].Semin Thorac Cardiovasc Surg,2003,15:310-314.
5 Yoon G,Kim TJ,Sung CO,et al.Benign metastasizing leiomyoma with multiple lymph node metastasis:a case report[J].Cancer Res Treat,2011,43:131-133.
6 Barnas'E,Ksiz6)ek M,Ras'R,et al.Benign metastasizing leiomyoma:A review of current literature in respect to the time and type of previous gynecological surgery[J].Plo S One,2017,12:e0175875.
7 Taveira-Da Silva AM,Alford CE,Levens ED,et al.Favorable response to antigonadal therapy for a benign metastasizing leiomyoma-.Obstet Gy-necol,2012,119:438-442.
8 Del Real-Romo ZJ,Montero-CantúC,Villegas-Cabello O,et al.Inciden-tal benign metastasizing leiomyoma in a patient with bone sarcoma:a case report[J].Case Rep Surg,2014,2014:439061.
9 Rege AS,Snyder JA,Scott WJ.Benign metastasizing leiomyoma:a rare cause of multiple pulmonary nodules[J].Ann Thorac Surg,2012,93:e149-e151.
10 Ras'R,Ksiz6)ek M,Barnas'E,et al.Benign metastasizing leiomyoma in triple location:lungs,parametria and appendix[J].Przeglad Menopauzalny=Menopause Review,2016,15:117-121.
11 Ma H,Cao J.Benign pulmonary metastasizing leiomyoma of the uterus:A case report[J].Oncol Lett,2015,9:1347-1350.
12 Yoon G,Kim TJ,Sung CO,et al.Benign metastasizing leiomyoma with multiple lymph node metastasis:a case report[J].Cancer Res Treat,2011,43:131-133.
13 Lim SY,Park JC,Bae JG,et al.Pulmonary and retroperitoneal benign me-tastasizing leiomyoma[J].Clin Exp Reprod Med,2011,38:174-177.
14 Yu R,Ferri M.An unusual cause of pulmonary nodules in the emergency department[J].Case Rep Emerg Med,2015,2015:278020.
15 Kayser K,Zink S,Schneider T,et al.Benign metastasizing leiomyoma of the uterus:documentation of clinical,immunohistochemical and lectin histochemical data of ten cases[J].Virchows Arch,2000,437:284-92.
16 Efared B,Atsame-Ebang G,Sani R,et al.Unexpected pulmonary tumor:metastasis from a benign uterine leiomyoma in a post-menopausal woman:a case report[J].BMC Research Notes,2017,10:662.
17 Lee HJ,Choi J,Kim KR.Pulmonary benign metastasizing leiomyoma associated with intravenous leiomyomatosis of theuterus:clinical behavior and genomic changes supporting a transportation theory[J].Int J Gynecol Pathol,2008,27:340-345.
18 Bowen JM,Cates JM,Kash S,Itani D,Gonzalez A,Huang D,et al.Genomic imbalances in benign metastasizing leiomyoma:characterization by conventional karyotypic,fluorescence in situ hybridization,and whole genome SNP array analysis[J].Cancer Genet,2012,205:249-254.
19 Miller J,Shoni M,Siegert C,et al.Benign metastasizing leiomyomas to the lungs:an institutional case series and a review of the recent literature[J].Ann Thorac Surg,2016,101:253-258.
20 Awonuga AO,Shavell VI,Imudia AN,et al.Pathogenesis of benign metastasizing leiomyoma:a review[J].Obstet Gynecol Surv,2010,65:189-195.
21 Tohya T,Tajima T,Takeshita Y,et al.Case of concurrent benign metastasizing leiomyoma in the lung and retroperitoneum,with a focus on its etiology[J].J Obstet Gynaecol Res,2014,40:2010-2013.
22 Schwarzbach MH,Dimitrakopoulou-Strauss A,Willeke F,et al.Clinical value of18F fluorode-oxyglucose positron emission tomography imaging in soft tissue sarcomas[J].Ann Surg,2000,231:380-386.
23 Nagamatsu A,Umesaki N,Li L,et al.Use of18F-fluorodeoxyglucose positron emission tomography for diagnosis of uterine sarcomas[J].Oncol Rep,2010,23:1069-1076.
24 Sawai Y,Shimizu T,Yamanaka Y,et al.Benign metastasizing leiomyoma and18F-FDG-PET/CT:A case report and literature review[J].Oncology Letters,2017,14:3641-3646.
25 Fan D,Yi X.Pulmonary benign metastasizing leiomyoma:a case report[J].Int J Clin Exp Pathol,2014,7:7072-7075.
26 Silva I,ToméV,Oliveira J.Benign metastasising leiomyoma:a progres sive disease despite chemical and surgical castration[J].BMJCase Rep,2012,2012:bcr0120125505.
27 Song KS,Keum DY.Malignant Transformation of Pulmonary Benign Metastasizing Leiomyoma[J].The Korean Journal of Thoracic and Cardiovascular Surgery,2017,50:59-63.
2 Taftaf R,Starnes S,Wang J,et al.Benign metastasizing leiomyoma:A rare type of lung metastases-two case reports and review of the literature[J].Case Rep Oncol Med,2014:842841,2014.
3 Egberts JH,Schafmayer C,Bauerschlag DO,et al.Benign abdominal and pulmonary metastasizing leiomyoma of the uterus[J].Arch Gynecol Obstet,2006,274:319-322.
4 Allen MS.Multiple benign lung tumors[J].Semin Thorac Cardiovasc Surg,2003,15:310-314.
5 Yoon G,Kim TJ,Sung CO,et al.Benign metastasizing leiomyoma with multiple lymph node metastasis:a case report[J].Cancer Res Treat,2011,43:131-133.
6 Barnas'E,Ksiz6)ek M,Ras'R,et al.Benign metastasizing leiomyoma:A review of current literature in respect to the time and type of previous gynecological surgery[J].Plo S One,2017,12:e0175875.
7 Taveira-Da Silva AM,Alford CE,Levens ED,et al.Favorable response to antigonadal therapy for a benign metastasizing leiomyoma-.Obstet Gy-necol,2012,119:438-442.
8 Del Real-Romo ZJ,Montero-CantúC,Villegas-Cabello O,et al.Inciden-tal benign metastasizing leiomyoma in a patient with bone sarcoma:a case report[J].Case Rep Surg,2014,2014:439061.
9 Rege AS,Snyder JA,Scott WJ.Benign metastasizing leiomyoma:a rare cause of multiple pulmonary nodules[J].Ann Thorac Surg,2012,93:e149-e151.
10 Ras'R,Ksiz6)ek M,Barnas'E,et al.Benign metastasizing leiomyoma in triple location:lungs,parametria and appendix[J].Przeglad Menopauzalny=Menopause Review,2016,15:117-121.
11 Ma H,Cao J.Benign pulmonary metastasizing leiomyoma of the uterus:A case report[J].Oncol Lett,2015,9:1347-1350.
12 Yoon G,Kim TJ,Sung CO,et al.Benign metastasizing leiomyoma with multiple lymph node metastasis:a case report[J].Cancer Res Treat,2011,43:131-133.
13 Lim SY,Park JC,Bae JG,et al.Pulmonary and retroperitoneal benign me-tastasizing leiomyoma[J].Clin Exp Reprod Med,2011,38:174-177.
14 Yu R,Ferri M.An unusual cause of pulmonary nodules in the emergency department[J].Case Rep Emerg Med,2015,2015:278020.
15 Kayser K,Zink S,Schneider T,et al.Benign metastasizing leiomyoma of the uterus:documentation of clinical,immunohistochemical and lectin histochemical data of ten cases[J].Virchows Arch,2000,437:284-92.
16 Efared B,Atsame-Ebang G,Sani R,et al.Unexpected pulmonary tumor:metastasis from a benign uterine leiomyoma in a post-menopausal woman:a case report[J].BMC Research Notes,2017,10:662.
17 Lee HJ,Choi J,Kim KR.Pulmonary benign metastasizing leiomyoma associated with intravenous leiomyomatosis of theuterus:clinical behavior and genomic changes supporting a transportation theory[J].Int J Gynecol Pathol,2008,27:340-345.
18 Bowen JM,Cates JM,Kash S,Itani D,Gonzalez A,Huang D,et al.Genomic imbalances in benign metastasizing leiomyoma:characterization by conventional karyotypic,fluorescence in situ hybridization,and whole genome SNP array analysis[J].Cancer Genet,2012,205:249-254.
19 Miller J,Shoni M,Siegert C,et al.Benign metastasizing leiomyomas to the lungs:an institutional case series and a review of the recent literature[J].Ann Thorac Surg,2016,101:253-258.
20 Awonuga AO,Shavell VI,Imudia AN,et al.Pathogenesis of benign metastasizing leiomyoma:a review[J].Obstet Gynecol Surv,2010,65:189-195.
21 Tohya T,Tajima T,Takeshita Y,et al.Case of concurrent benign metastasizing leiomyoma in the lung and retroperitoneum,with a focus on its etiology[J].J Obstet Gynaecol Res,2014,40:2010-2013.
22 Schwarzbach MH,Dimitrakopoulou-Strauss A,Willeke F,et al.Clinical value of18F fluorode-oxyglucose positron emission tomography imaging in soft tissue sarcomas[J].Ann Surg,2000,231:380-386.
23 Nagamatsu A,Umesaki N,Li L,et al.Use of18F-fluorodeoxyglucose positron emission tomography for diagnosis of uterine sarcomas[J].Oncol Rep,2010,23:1069-1076.
24 Sawai Y,Shimizu T,Yamanaka Y,et al.Benign metastasizing leiomyoma and18F-FDG-PET/CT:A case report and literature review[J].Oncology Letters,2017,14:3641-3646.
25 Fan D,Yi X.Pulmonary benign metastasizing leiomyoma:a case report[J].Int J Clin Exp Pathol,2014,7:7072-7075.
26 Silva I,ToméV,Oliveira J.Benign metastasising leiomyoma:a progres sive disease despite chemical and surgical castration[J].BMJCase Rep,2012,2012:bcr0120125505.
27 Song KS,Keum DY.Malignant Transformation of Pulmonary Benign Metastasizing Leiomyoma[J].The Korean Journal of Thoracic and Cardiovascular Surgery,2017,50:59-63.