Metastasizing Bronchopulmonary Leiomyosarcoma.
Bottom Line: Two thoracenteses failed to reveal any cytologic abnormalities.Bronchoscopy revealed smooth, round, endobronchial lesions.Histologic examination showed features consistent with leiomyosarcoma.
Affiliation: Georgia Regents University, Augusta, GA, USA.
An otherwise healthy 55-year-old female, nonsmoker, was seen in pulmonary consultation for progressively worsening shortness of breath. She had undergone a complete hysterectomy 7 years prior for bleeding leiomyomas. On presentation, her initial chest X-ray showed a large right-sided pleural effusion with multiple pulmonary nodules. Two thoracenteses failed to reveal any cytologic abnormalities. Bronchoscopy revealed smooth, round, endobronchial lesions. Histologic examination showed features consistent with leiomyosarcoma. We present a rare case of a patient that initially had possible leiomyomas of the uterus surgically removed and years later presented with bronchopulmonary leiomyosarcoma.
No MeSH data available.
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Mentions: We present a case of a 55-year-old female that presented with a 3-week history of shortness of breath, cough, and right-sided pleuritic chest pain. The patient was a nonsmoker and had a significant past medical history of complete hysterectomy 7 years prior for bleeding uterine fibroids. Pathology at that time had shown the fibroids to be leiomyomas. On current presentation, her chest X-ray showed multiple pulmonary nodules with a large right-sided pleural effusion. Subsequently, a computed tomography scan of the chest, abdomen, and pelvis revealed numerous bilateral pulmonary nodules with a large pleural effusion, and near complete collapse of the right middle and right lower lobes (Figure 1). The sizes of the nodules was not documented but had borders that were circular and distinct. There were no abnormal lesions seen under the diaphragm. Two thoracenteses revealed bloody, exudative, pleural fluid but cytology failed to reveal any evidence of malignancy. Bronchoscopy of the right lung revealed extrinsic compression of the airways in the right middle and right lower lobe with no intrabronchial lesions. However, there was a large nonendobronchial mass on the right side causing atelectasis and collapse. Being the focus of the bronchoscopy, the left lung revealed 2 endobronchial lesions: one in the apicoposterior segment of the left upper lobe and one within the basilar segments of the left lower lobe. The lesions were smooth, round, and freely mobile with the patient’s inspiratory and expiratory effort. Each was anchored to the inside of the airways by thin stalks (Figure 2). Biopsy of one of these lesions showed the lesions to be very friable. Histopathology revealed proliferating spindle cells that were highlighted with smooth muscle actin and desmin (Figure 3). With the pleural effusion returning, the patient subsequently underwent a video-assisted thoracoscopic surgery (VATS) procedure to obtain more tissue for further histologic investigation and symptomatic relief. Pathology results of the VATS revealed a low-grade leiomyosarcoma. The patient was referred to Hematology/Oncology, and a positron emission tomography and computed tomography scan (PET-CT) was completed. The PET-CT scan showed bilateral, innumerable hypermetabolic masses in both lungs (Figure 4). There was also bilateral mediastinal and hilar lymphadenopathy, which had no significant uptake. In addition, there was a multiloculated, mildly active, pleural effusion. The patient was felt to be a poor surgical candidate due to the vast number of pulmonary tumors present. She was started on a course of chemotherapy consisting of docetaxel (taxotere) and gemcitabine (gemzar). As of June 31, 2011, the patient has been tolerating chemotherapy with minimal side effects and was scheduled for a follow-up PET-CT in July 2011.
No MeSH data available.