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Hormonal Manipulation of Benign Metastasizing Leiomyomas: Report of Two Cases and Review of the Literature

Division of Endocrinology (J.A.R., S.C.), McGill University Health Centre, Montréal, Québec H3A 1A1, Canada; and Division of Respirology (D.S.) and Lady Davis Institute and Division of Endocrinology (M.T.), SMBD Jewish General Hospital, Montréal, Québec H3T 1E2, Canada

Address all correspondence and requests for reprints to: Dr. Juan-Andres Rivera, Royal Victoria Hospital, 687 Pine Avenue West, Room M3.15, Montréal, Québec H3A 1A1, Canada. E-mail: juan.rivera{at}mcgill.ca.

Benign metastasizing leiomyomas (BMLs) occur predominantly in women during reproductive years. The condition is characterized by uterine leiomyomas associated with the development, typically years later, of slow-growing metastatic lesions. The most commonly affected organs are the lungs, but BMLs have been reported in lymph nodes, deep soft tissues, mesentery, bones, the central nervous system, and the heart. In many cases, these lesions have an indolent course and are discovered rather incidentally. However, occasionally they can present with debilitating symptoms or even life-threatening complications. The presence of estrogen and progesterone receptors in these tumors supports their origin from uterine smooth muscle and, more importantly, makes them amenable to hormonal manipulation. Radical interventions, such as extensive tumor debulking and oophorectomy for hormonal control, although effective in many cases, are not always possible or desirable and carry significant morbidity. Here we present two cases of BMLs to illustrate the role of newer therapeutic agents, the estrogen receptor modulators and the aromatase inhibitors, in the hormonal manipulation of these tumors.

This work was supported in part by awards (to J.A.R.) from the Research Institute of the McGill University Health Centre and the Fundacion Gran Mariscal de Ayacucho (Venezuela).

Abbreviations: AI, Aromatase inhibitor; BML, benign metastasizing leiomyoma; ER, estrogen receptor; HPF, high-power field; MRI, magnetic resonance image; PR, progesterone receptor; SERM, selective estrogen receptor modulator.

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