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Metastasizing leiomyoma to heart.

Erin N Consamus1, Michael J Reardon1, Alberto G Ayala1

  • 1Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College of Cornell University, New York, New York.

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Benign metastasizing leiomyoma, a rare uterine tumor, can spread to the heart years after initial treatment. This case highlights the importance of considering uterine leiomyoma history in cardiac tumor diagnoses, especially with prior lung metastasis.

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Area of Science:

  • Cardiovascular Pathology
  • Oncology
  • Gynecologic Oncology

Background:

  • Cardiac smooth muscle tumors are exceptionally rare, with most cases involving intravenous extension of pelvic leiomyomas.
  • Benign metastasizing leiomyoma (BML) is a distinct entity, originating from uterine smooth muscle tumors and capable of distant metastasis.

Observation:

  • A 55-year-old woman presented with a cardiac tumor 17 years post-hysterectomy and 16 years after pulmonary metastasis.
  • Immunohistochemical analysis confirmed the tumor as smooth muscle actin, desmin, and hormone receptor-positive, consistent with uterine leiomyoma origin.

Findings:

  • This represents the fourth reported case of BML to the heart.
  • It is the first documented instance of long-delayed cardiac metastasis following successful treatment of pulmonary metastases from a uterine leiomyoma.

Implications:

  • BML should be considered in the differential diagnosis of cardiac tumors, particularly in women with a history of uterine leiomyoma.
  • The long latency period underscores the need for vigilant long-term follow-up in patients with a history of uterine leiomyoma and metastatic disease.