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"autores" => array:3 [ 0 => array:4 [ "nombre" => "Anna" "apellidos" => "Soler Sendra" "email" => array:1 [ 0 => "asoler@fphag.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María del Valle" "apellidos" => "Rodriguez Santas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Andrea" "apellidos" => "Rodríguez Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General de Granollers, Granollers, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomia Patológica, Hospital General de Granollers, Granollers, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Traumatologia, Hospital General de Granollers, Granollers, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leiomiomatosis metastatizante benigna: presentación de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 551 "Ancho" => 755 "Tamanyo" => 61413 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET-CT. Lung nodules.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Benign metastatic leiomyomatosis is a rare entity of which approximately 100 cases have been described in the medical literature. It usually affects women with a history of hysterectomy. It is characterised by the development of benign tumours corresponding to leiomyomas that spread to other organs, especially the lungs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an incidental diagnosis due to SARS-CoV-2 pneumonia.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 54-year-old female patient with a history of hysterectomy 20 years earlier due to uterine leiomyoma. She visited the emergency department for acute cough and fever and was diagnosed with SARS-CoV-2 pneumonia. A chest X-ray showed multiple bilateral pulmonary nodules compatible with metastases. For this reason, a chest CT scan was performed, which showed the presence of multiple nodular lesions of different sizes and densities suggestive of a neoplastic process. The work-up was completed with an abdominal CT scan, which detected the presence of solid nodules involving the psoas muscles and a peritoneal nodule in the hypogastrium.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the SARS-CoV-2 infection, the patient had a favourable progression. She was referred to the outpatient clinic in order to complete the work-up. A new chest-abdominal CT scan was performed a month later, which confirmed countless nodules and pulmonary masses suggestive of metastasis. Stability of the nodule in the greater omentum and of the nodules located in the muscular compartment of both proximal limbs were observed. Bone lesions that could correspond to metastases were identified. Soft tissue ultrasound of both legs showed multiple solid lesions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Paradoxically, the patient showed an excellent clinical condition at all times, reporting that she had been feeling tumours in her legs for years. It was decided to complete the study with a PET-CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which reported uptake in the bilateral pulmonary nodules, the mediastinal lymph nodes, the hypogastric mesenteric node, the right quadriceps muscle node and another next to the left femur. The highest uptake by PET was SUV 2.38 in the right quadriceps muscle.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">One of the most accessible 5 × 5 cm muscle masses was removed, showing an encapsulated tumour surrounded by multiple varicose vessels. Anatomical pathology evidenced an encapsulated tumour consisting of smooth muscle fibres, with no obvious cytological atypia or areas of necrosis. The cells expressed actin, desmin and h-caldesmon. They were negative for CD34, S100 and CD117. The Ki67 cell proliferation index was 1%. Immunohistochemical determination for oestrogen and progesterone receptors was positive. Therefore, the mass was identified as a leiomyoma and the overall diagnosis was benign metastatic leiomyomatosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Benign metastatic leiomyomatosis is a rare disease, one of the forms of extrauterine leiomyomatosis,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> along with the intravenous form, disseminated and hereditary peritoneal leiomyomatosis. It was first described by Steiner<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 1939 and affects women with a mean age of 47 years who usually have a history of previous hysterectomy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A review by Barnas et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> analysed 214 articles on this entity up to 2016. Its aetiology is unclear, but hematogenous spread of leiomyoma emboli from previous surgery has been postulated. It is a histologically benign entity that is usually asymptomatic but can behave aggressively depending on growth due to the compression of neighbouring structures. The main organ affected is usually the lung, although they can occur in other sites, such as the retroperitoneum, heart, brain, mediastinum…</p><p id="par0045" class="elsevierStylePara elsevierViewall">The initial differential diagnosis includes metastases from an unknown primary tumour.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Imaging tests are essential for diagnosis, especially CT, ultrasound and magnetic resonance imaging. Regarding the role of PET-CT, not many cases have yet been described in the literature. In those that do,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> they report a certain increase in metabolism, which does not usually correspond to the indolent course of the lesions, as would be our case.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The diagnosis is pathological, confirming the hormone-dependent benign myomatous lesion. Immunohistochemistry shows that the cells are negative for the S100 protein and positive for desmin and actin.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment must be individualized, with a conservative approach being a therapeutic option in lesions that stabilize or even regress. Surgical removal should be indicated when there are associated symptoms. Hormone therapy<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> (with aromatase inhibitors) is the most widely accepted treatment, and in a large proportion of cases the disease can be controlled.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 551 "Ancho" => 755 "Tamanyo" => 61413 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET-CT. Lung nodules.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La léiomyomatose extra-utérine: revue de la litterature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Declas" 1 => "J.P. Lucot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gofs.2019.06.010" "Revista" => array:6 [ "tituloSerie" => "Gynécol Obstet Fertil Senol." "fecha" => "2019" "volumen" => "47" "paginaInicial" => "582" "paginaFinal" => "590" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31255836" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastasizing fibroleiomyoma of the uterus: report of a case and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.E. Steiner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Pathol." "fecha" => "1939" "volumen" => "15" "paginaInicial" => "89" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19970436" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign metastasizing leiomyoma: a review of current literature in respect to the time and type of previous gynecological surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Barnas" 1 => "M. Ksiazek" 2 => "R. Ras" 3 => "A. Skret" 4 => "J. Skret-Magierlo" 5 => "E. Dmoch-Gajzlerska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0175875" "Revista" => array:3 [ "tituloSerie" => "PloS ONE." "fecha" => "2017" "volumen" => "12" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leiomiomatosis benigna pulmonar metastatizante" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Palafox" 1 => "J. Palafox" 2 => "G. Aquino" 3 => "W.L. Dajer-Fadel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Patol Respir." "fecha" => "2012" "volumen" => "15" "paginaInicial" => "85" "paginaFinal" => "88" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leiomiomatosis benigna metastatizante: una extraña entidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Fernández Grande" 1 => "B. Couso Cambeiro" 2 => "M.D. Arias Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Invest Gin Obst." "fecha" => "2014" "volumen" => "41" "paginaInicial" => "38" "paginaFinal" => "41" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015900000007/v2_202301310815/S238702062200448X/v2_202301310815/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015900000007/v2_202301310815/S238702062200448X/v2_202301310815/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062200448X?idApp=UINPBA00004N" ]
