Benign metastasizing leiomyoma developed during hormone replacement therapy after total laparoscopic hysterectomy: A case report

Abstract

　Benign metastasizing leiomyoma (BML), a leiomyoma that metastasizes various parts of the body other than the uterus, is an extremely rare disease. We report a case of BML that developed during hormone replacement therapy after laparoscopic total hysterectomy (TLH) for uterine myoma. A 50-year-old woman presented with multiple myomas. After 4 courses of GnRH agonist, TLH and risk-reducing salpingectomy were performed. The operative time was 91 minutes, blood loss was 200 g, and the specimen weight was 1,050 g. The histopathological diagnosis of the specimen was leiomyoma with no malignant findings. She was started on estrogen replacement therapy for menopausal symptoms by a local doctor 3 years and 9 months after surgery. At 4 years and 4 months after the surgery, a pulmonary nodule was detected on chest computed tomography during the medical examination, and a thoracoscopic partial left lung resection was performed at the respiratory surgery department of another hospital. Histologically, the tumor was diagnosed as BML. She was referred back to our hospital for follow-up of the residual tumor, and estrogen replacement therapy was discontinued. At 5 years and 7 months after the initial surgery, she was doing well without tumor growth. It is important to recognize that BML can occur after laparoscopic surgery, and there is a possibility that HRT is a risk factor for BML.