Benign metastasizing uterine leiomyoma. A case series. Systematic review

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Abstract

Uterine leiomyoma (ULM) is one of the most common gynecological pathologies in women of reproductive age. The prevalence of this pathology varies across different age groups, with approximately 10% in the 20–35 age range, increasing to 40–45% after the age of 35. ULM metastasis is an extremely rare phenomenon, with only 411 cases reported in the literature, including our 3 observations. Several definitions exist, with the most common being benign metastasizing ULM, found in both domestic and foreign literature. Each observation is crucial, as there are currently no clear treatment algorithms for this patient category. The study presents 3 cases of successful treatment of patients with metastatic ULM in two institutions. A systematic review of domestic and foreign literature on this pathology is conducted. Twenty-two clinical observations in the Russian Federation and neighboring countries are analyzed. Analysis of foreign literature revealed records of 386 clinical observations of benign metastasizing ULM. Benign metastasizing ULM of the uterus represents a rare nosological form. Systematization is advisable for determining the optimal treatment and observation tactics.

About the authors

Evgeny A. Toneev

Regional Clinical Oncology Dispensary; Ulyanovsk State University

Author for correspondence.
Email: e.toneev@inbox.ru
ORCID iD: 0000-0001-8590-2350

Cand. Sci. (Med.)

Russian Federation, Ulyanovsk; Ulyanovsk

Roman F. Shagdaleev

Ulyanovsk State University

Email: e.toneev@inbox.ru
ORCID iD: 0009-0004-0218-666X

Clinical Resident

Russian Federation, Ulyanovsk

Svetlana N. Toneeva

Ulyanovsk Regional Clinical Hospital

Email: e.toneev@bk.ru
ORCID iD: 0009-0003-3101-881X

obstetrician-gynecologist

Russian Federation, Ulyanovsk

Yulia A. Karabanova

Regional Clinical Oncology Dispensary

Email: dergunova.yu@mail.ru
ORCID iD: 0000-0002-7499-2650

Cand. Sci. (Med.)

Russian Federation, Ulyanovsk

Alexander A. Martynov

Regional Clinical Oncology Dispensary

Email: e.toneev@bk.ru
ORCID iD: 0000-0003-4662-9886

thoracic surgeon

Russian Federation, Ulyanovsk

Grigorii N. Khabas

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: e.toneev@inbox.ru
ORCID iD: 0000-0002-5011-9152

Cand. Sci. (Med.)

Russian Federation, Moscow

Polina L. Sheshko

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: e.toneev@inbox.ru
ORCID iD: 0000-0003-3905-8026

Cand. Sci. (Med.)

Russian Federation, Moscow

Zalina R. Shebzukhova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: e.toneev@inbox.ru
ORCID iD: 0000-0002-6889-5803

obstetrician-gynecologist

Russian Federation, Moscow

Vlada V. Kometova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: e.toneev@inbox.ru
ORCID iD: 0000-0001-9666-6875

Cand. Sci. (Med.)

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Uterine leiomyoma (ULM). Hematoxylin and eosin staining, ×20.

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3. Fig. 2. Multispiral computed tomography (MSCT). The arrow indicates the neoplasm in the abdominal space.

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4. Fig. 3. MSCT scan. Arrows indicate formations in the liver and altered lymph nodes at the hepatic hilum.

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5. Fig. 4. MSCT scan. The arrow indicates the neoplasm in the lower lobe of the right lung.

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6. Fig. 5. MSCT scan. The arrow indicates the neoplasm in the upper lobe of the left lung.

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7. Fig. 6. Benign metastasizing LM. Hematoxylin and eosin staining, ×20.

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8. Fig. 7. Benign metastasizing LM. Immunohistochemical staining with SMA antibodies (a) and estrogen receptor antibodies (b), ×20.

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9. Fig. 8. Microphotograph of metastatic ULM (benign mesenchymal tumor) represented by bundles of interwoven spindle-shaped smooth muscle cells without atypia. Hematoxylin and eosin staining, ×100.

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10. Fig. 9. Metastasis of LM to the para-aortic lymph node: a – residual tissue of the lymph node; b – metastatic tissue of LM. Hematoxylin and eosin staining, ×100.

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11. Fig. 10. Positive nuclear expression of progesterone receptors in 100% of LM cells. Immunohistochemical reaction with progesterone receptor (clone 1E2).

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12. Fig. 11. Positive expression of caldesmon marker in tumor cells, corresponding to the smooth muscle origin of tumor cells (LM). Immunohistochemical reaction with caldesmon (clone E-89).

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13. Fig. 12. Low proliferative activity of tumor cells. Ki-67 – 5%. Immunohistochemical reaction with Ki-67 (clone 30-9).

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14. Fig. 13. Microphotograph of multiple metastatic nodes in the greater omentum. Hematoxylin and eosin staining, ×20.

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