肺良性轉移性平滑肌瘤一例診療體會及文獻復習_《中國呼吸與危重監護雜志》

作者：

陳石 ^1,2 , 劉銳敏 ³ , 張靜瑩 ² , 黃茂 ¹

1 南京醫科大學第一附屬醫院呼吸科( 江蘇南京210029) ;;
2 江蘇省中醫院呼吸科( 江蘇南京210029);;
3 南京大學醫學院附屬鼓樓醫院內科( 江蘇南京210008) 通信作者: 黃茂, E-mail: hm6114@ 126. com;

關鍵詞：

良性轉移性平滑肌瘤子宮肌瘤切除術肺轉移肺活檢

DOI：

DOI: 10 . 7507 /1671 -6205 . 20130114

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目的提高對肺良性轉移性平滑肌瘤的認識。
方法回顧分析南京醫科大學第一附屬醫院2012 年10 月診斷的1 例肺良性轉移性平滑肌瘤, 并復習相關文獻。
結果患者為32 歲女性, 行子宮肌瘤切除術1 個月后出現活動后胸悶、氣喘, 乏力明顯, 胸部CT 示兩肺彌漫分布粟粒狀影, 血腫瘤標記物正常。予抗結核治療4 周后復查胸部CT 無明顯變化, 遂予胸腔鏡肺活檢。HE 染色顯示腫瘤細胞具有平滑肌細胞的分化特征; 免疫組化提示腫瘤細胞增殖指數較低, 不支持肺部惡性腫瘤; Desmin、SMA 平滑肌特異性標志物強陽性; 雌激素受體、孕激素受體表達強陽性, 符合肺良性轉移性平滑肌瘤的特點。確診后即給予口服三苯氧胺( tamoxifen) 抗雌激素治療3 個月。目前患者無疾病繼續發展及進一步遠處轉移的放射學證據, 仍在繼續隨訪。
結論良性轉移性平滑肌瘤是一種會發生在任何年齡組的罕見疾病, 最常見于晚育女性, 所有患者均有子宮的平滑肌瘤歷史和/ 或行子宮肌瘤切除術, 并且常常合并有遠離子宮部位的轉移, 其中以肺部最多見。

引用本文： 陳石 ,劉銳敏,張靜瑩,黃茂. 肺良性轉移性平滑肌瘤一例診療體會及文獻復習. 中國呼吸與危重監護雜志, 2013, 12(5): 472-476. doi: DOI: 10 . 7507 /1671 -6205 . 20130114 復制

1.	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.Virchows Arch,2000, 437: 284 -292.
2.	Kwon YI, Kim TH, Sohn JW, et al. Benign pulmonary metastasizing leiomvomatosis: case report and a review of the literature. Korean J Intern Med, 2006, 21: 173 -177.
3.	Jo JH, Lee JH, Kim DC, et al. A case of benign metastasizing leiomyoma with multiple metastasis to the soft tissue, skeletal muscle, lung and breast. Korean J Intern Med, 2006, 21: 199-201.
4.	Yoon G, Kim TJ, Sung CO, et al. Benign metastasizing leiomyoma with multiple lymph node metastasis: a case report. Cancer Res Treat, 2011 , 43: 131-133.
5.	Kang SA, Choi SI, Kim YA, et al. A case of benign metastasizing pulmonary leiomyoma. Tuberc Respir Dis, 2005, 58: 614-618 .
6.	Egberts JH, Schafmayer C, Bauerschlag DO, et al. Benign abdominal and pulmonary metastasizing leiomyoma of the uterus. Arch Gynecol Obstet, 2006, 274 : 319-322.
7.	Abramson S, Gilkeson RC, Goldstein JD, et al. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. Am J Roentgenol, 2001, 176: 1409-1413.
8.	Patton KT, Cheng L, Papavero V, et al. Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis.Mod Pathol, 2006 , 19 : 130-140.
9.	Esteban JM, Allen WM, Schaerf RH. Benign metastasizing leiomyoma of the uterus: histologic and immunohistochemical characterization of primary and metastatic lesions. Arch Pathol Lab Med, 1999, 123 : 960-962.
10.	Jautzke G, Muller-Ruchholtz E, Thalmann U. Immunohistological detection of estrogen and progesterone receptors in multiple and well differentiated leiomyomatous lung tumors in women with uterine leiomyomas ( so-called benign metastasizing leiomyomas) . A report on 5 cases. Pathol Res Pract, 1996, 192 : 215-223.
11.	Nucci MR, Drapkin R, Cin PD, et al. Distinctive cytogenetic profile in benign metastasizing leiomyoma: pathogenic implications. Am J Surg Path, 2007, 31: 737 -743.
12.	Tietze L, Gunther K, Horbe A, et al. Benign metastasizing leiomyoma: a cytogenetically balanced but clonal disease. Hum Pathol, 2000 , 31: 126-128.
13.	Nuovo GJ, Schmittgen TD. Benign metastasizing leiomyoma of the lung: clinicopathologic, immunohistochemical, and micro-RNA analyses. Diagn Mol Pathol, 2008, 17: 145-150.
14.	Steiner P. Metastasizing fibroleiomyoma of the uterus: report of a case and review of the literature. Am J Pathol, 1939, 15: 89 -107.
15.	Robboy SJ, Bentley RC, Butnor K, et al. Pathology and pathophysiology of uterine smooth muscle tumors. Environ Health Perspect, 2000, 5 Suppl: 779-784.
16.	Canzonieri V, D′Amore ES, Bartoloni G, et al. Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis. Virchows Arch, 1994, 425 : 541-545.
17.	Koh DM, Burn PR, King DM. Benign metastasizing leiomyoma with intracaval leiomyomatosis. Br J Radio, 2000, 73: 435-437.
18.	Martin E. Leiomyomatous lung lesions: a proposed classification.Am J Roentgenol, 1983, 141 : 269-272.
19.	Horstmann JP, Pietra GG, Harman JA, et al. Spontaneous regression of pulmonary leiomyomas during pregnancy. Cancer, 1977,39:314-321.
20.	Fu Y, Li H, Tian B, et al. Pulmonary benign metastasizing leiomyoma: a case report and review of the literature. World J Surg Oncol, 2012 , 10 : 268.
21.	Radzikowska E, Szczepulska-Wójcik E, Langfort R, et al. Benign pulmonary metastasizing leiomyoma uteri. Case report and review of literature. Pneumonol Alergol Pol, 2012, 80: 560 -564.
22.	Rivera JA, Christopoulos S, Small D, et al. Hoimonalmanipulation of benign metastasizing leiomyomas: report of two case and review of the literature. J Clin Endocrinol Metab, 2004 , 89: 3183-3188.
23.	Ni Y, Shi G, Wan H, et al. Pulmonary benign metastasizing leiomyoma: case report and review of the literature. Clin Exp Obstet Gynecol, 2012, 39: 249 -251.
24.	Goyle KK, Moore DF Jr, Garrett C, et al. Benign metastasizing leiomyomatosis: case report and review. Am J Clin Oncol, 2003, 26 :473-476.
25.	Yamazaki K. CD102 and CD342 positive periglandular stromalcells in pulmonary bening metastasizing leiomyoma with metaplastic adenomyomatous glands: an ultrastructural and immunohistochemical study. Virchow Arch, 2005 , 446: 270-277.
26.	張云, 楊小豐, 王瑜, 等. 肺良性轉移性平滑肌瘤PET/CT 顯像一例. 中華核醫學雜志, 2007, 27 : 380.
27.	Yonezawa K, Yokoo N, Yamaguchi T. Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery. Surg Today, 1999 , 29 :.
28.	Abu-Rustum NR, Curtin JP, Burt M, et al. Regression of utenine low-grade smooth muscle tumors metastatic to the lung after ooghorectomy. Obstet Gynecol, 1997 , 89( 5 Pt 2) : 850-852.
29.	Mogi A, Hirato J, Kosaka T, et al. Benign metastasizing leiomyoma of the lung: report of a case. Gen Thorac Cardiovasc Surg, 2012. [ Epub ahead of print].
30.	Lewis EI, Chason RJ, Decherney AH, et al. Novel hormone treatment of benign metastasizing leiomyoma: an analysis of five cases and literature review. Fertil Steril, 2013 , 99: 2017-2024.
31.	張雯月, 李敏, 楊紅忠, 等. 肺良性轉移性平滑肌瘤1 例. 中國肺癌雜志, 2012, 15 : 56 -58.
32.	倪穎夢, 時國朝, 沈繼敏, 等. 肺良性轉移性平滑肌瘤一例. 中華結核和呼吸雜志, 2009, 32: 779 -780.
33.	朱富新, 孫恒. 肺良性轉移性平滑肌瘤( 附1 例臨床與病理分析) . 中國腫瘤臨床, 2011, 38: 533.
34.	-824.

1. 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.Virchows Arch,2000, 437: 284 -292.
2. Kwon YI, Kim TH, Sohn JW, et al. Benign pulmonary metastasizing leiomvomatosis: case report and a review of the literature. Korean J Intern Med, 2006, 21: 173 -177.
3. Jo JH, Lee JH, Kim DC, et al. A case of benign metastasizing leiomyoma with multiple metastasis to the soft tissue, skeletal muscle, lung and breast. Korean J Intern Med, 2006, 21: 199-201.
4. Yoon G, Kim TJ, Sung CO, et al. Benign metastasizing leiomyoma with multiple lymph node metastasis: a case report. Cancer Res Treat, 2011 , 43: 131-133.
5. Kang SA, Choi SI, Kim YA, et al. A case of benign metastasizing pulmonary leiomyoma. Tuberc Respir Dis, 2005, 58: 614-618 .
6. Egberts JH, Schafmayer C, Bauerschlag DO, et al. Benign abdominal and pulmonary metastasizing leiomyoma of the uterus. Arch Gynecol Obstet, 2006, 274 : 319-322.
7. Abramson S, Gilkeson RC, Goldstein JD, et al. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. Am J Roentgenol, 2001, 176: 1409-1413.
8. Patton KT, Cheng L, Papavero V, et al. Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis.Mod Pathol, 2006 , 19 : 130-140.
9. Esteban JM, Allen WM, Schaerf RH. Benign metastasizing leiomyoma of the uterus: histologic and immunohistochemical characterization of primary and metastatic lesions. Arch Pathol Lab Med, 1999, 123 : 960-962.
10. Jautzke G, Muller-Ruchholtz E, Thalmann U. Immunohistological detection of estrogen and progesterone receptors in multiple and well differentiated leiomyomatous lung tumors in women with uterine leiomyomas ( so-called benign metastasizing leiomyomas) . A report on 5 cases. Pathol Res Pract, 1996, 192 : 215-223.
11. Nucci MR, Drapkin R, Cin PD, et al. Distinctive cytogenetic profile in benign metastasizing leiomyoma: pathogenic implications. Am J Surg Path, 2007, 31: 737 -743.
12. Tietze L, Gunther K, Horbe A, et al. Benign metastasizing leiomyoma: a cytogenetically balanced but clonal disease. Hum Pathol, 2000 , 31: 126-128.
13. Nuovo GJ, Schmittgen TD. Benign metastasizing leiomyoma of the lung: clinicopathologic, immunohistochemical, and micro-RNA analyses. Diagn Mol Pathol, 2008, 17: 145-150.
14. Steiner P. Metastasizing fibroleiomyoma of the uterus: report of a case and review of the literature. Am J Pathol, 1939, 15: 89 -107.
15. Robboy SJ, Bentley RC, Butnor K, et al. Pathology and pathophysiology of uterine smooth muscle tumors. Environ Health Perspect, 2000, 5 Suppl: 779-784.
16. Canzonieri V, D′Amore ES, Bartoloni G, et al. Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis. Virchows Arch, 1994, 425 : 541-545.
17. Koh DM, Burn PR, King DM. Benign metastasizing leiomyoma with intracaval leiomyomatosis. Br J Radio, 2000, 73: 435-437.
18. Martin E. Leiomyomatous lung lesions: a proposed classification.Am J Roentgenol, 1983, 141 : 269-272.
19. Horstmann JP, Pietra GG, Harman JA, et al. Spontaneous regression of pulmonary leiomyomas during pregnancy. Cancer, 1977,39:314-321.
20. Fu Y, Li H, Tian B, et al. Pulmonary benign metastasizing leiomyoma: a case report and review of the literature. World J Surg Oncol, 2012 , 10 : 268.
21. Radzikowska E, Szczepulska-Wójcik E, Langfort R, et al. Benign pulmonary metastasizing leiomyoma uteri. Case report and review of literature. Pneumonol Alergol Pol, 2012, 80: 560 -564.
22. Rivera JA, Christopoulos S, Small D, et al. Hoimonalmanipulation of benign metastasizing leiomyomas: report of two case and review of the literature. J Clin Endocrinol Metab, 2004 , 89: 3183-3188.
23. Ni Y, Shi G, Wan H, et al. Pulmonary benign metastasizing leiomyoma: case report and review of the literature. Clin Exp Obstet Gynecol, 2012, 39: 249 -251.
24. Goyle KK, Moore DF Jr, Garrett C, et al. Benign metastasizing leiomyomatosis: case report and review. Am J Clin Oncol, 2003, 26 :473-476.
25. Yamazaki K. CD102 and CD342 positive periglandular stromalcells in pulmonary bening metastasizing leiomyoma with metaplastic adenomyomatous glands: an ultrastructural and immunohistochemical study. Virchow Arch, 2005 , 446: 270-277.
26. 張云, 楊小豐, 王瑜, 等. 肺良性轉移性平滑肌瘤PET/CT 顯像一例. 中華核醫學雜志, 2007, 27 : 380.
27. Yonezawa K, Yokoo N, Yamaguchi T. Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery. Surg Today, 1999 , 29 :.
28. Abu-Rustum NR, Curtin JP, Burt M, et al. Regression of utenine low-grade smooth muscle tumors metastatic to the lung after ooghorectomy. Obstet Gynecol, 1997 , 89( 5 Pt 2) : 850-852.
29. Mogi A, Hirato J, Kosaka T, et al. Benign metastasizing leiomyoma of the lung: report of a case. Gen Thorac Cardiovasc Surg, 2012. [ Epub ahead of print].
30. Lewis EI, Chason RJ, Decherney AH, et al. Novel hormone treatment of benign metastasizing leiomyoma: an analysis of five cases and literature review. Fertil Steril, 2013 , 99: 2017-2024.
31. 張雯月, 李敏, 楊紅忠, 等. 肺良性轉移性平滑肌瘤1 例. 中國肺癌雜志, 2012, 15 : 56 -58.
32. 倪穎夢, 時國朝, 沈繼敏, 等. 肺良性轉移性平滑肌瘤一例. 中華結核和呼吸雜志, 2009, 32: 779 -780.
33. 朱富新, 孫恒. 肺良性轉移性平滑肌瘤( 附1 例臨床與病理分析) . 中國腫瘤臨床, 2011, 38: 533.
34. -824.

《中國呼吸與危重監護雜志》

肺良性轉移性平滑肌瘤一例診療體會及文獻復習

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《中國呼吸與危重監護雜志》

肺良性轉移性平滑肌瘤一例診療體會及文獻復習

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