Recurrent benign metastasizing leiomyoma after hysterectomy and bilateral salpingo-oophorectomy
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Awoniyi O Awonuga1, Michael Rotas, Anthony N Imudia
1Division of Reproductive Endocrinology and Infertility, Wayne State University/Detroit Medical Center, 3750 Woodward Ave. Suite 200-D, Detroit, MI 48201, USA. niyiawonuga@aol.com
Background:
Benign uterine leiomyomas are sometimes found in association with benign smooth muscle tumors outside the confines of the uterus and are given the name benign metastasizing leiomyomas (BML). We present two patients who were on estrogen replacement therapy, in which BML recurred twice despite previous hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) requiring two additional laparotomies.
Patients:
Our patients, presented with multiple abdominal masses 6 years after their initial surgery for benign leiomyoma. At exploratory laparotomy multiple benign leiomyomas were resected, and in one case a 2.2 cm leiomyoma was also resected from the left lower lobe of the lung. Both patients had a third laparotomy for another abdominal recurrence approximately 2 years later.
Results:
Pathology revealed benign leiomyomas with no cytological atypia and a mitotic count of <5 per 10 high power fields (hpf).
Conclusion:
Benign metastasizing leiomyoma rarely follow TAH/BSO in patients with uterine myoma and estrogen replacement therapy may play a role in such occurrence. Despite surgery to remove these tumors, they can still recur; therefore, there is need for prolonged surveillance in such patients after resection.
