雙肺都轉移了，怎麼還是良性腫瘤？

70 / F；chest pain (onset: 2 days ago), past history of pelvic surgery (50 years ago), non-smoker

70歲，女性；胸痛2天，既往史：50年前盆腔手術史，非吸煙患者。

圖4 胸部CT增強

Figure 1. Chest PA shows multiple nodules and masses in both lungs with left pneumothorax. There was another previous chest PA from outside hospital taken 10 years ago.

圖1.X光顯示兩肺多髮結節或腫塊伴左側氣胸。外院10年前另一X光。（小編：前後對比病變明顯進展）

Figure 2-4. On chest CT after chest tube insertion in left hemithorax, there are multiple nodules and masses with/without cavity in both lungs.

圖2-4.胸部CT顯示左側氣胸置管後，兩肺多髮結節或腫塊伴或不伴空洞。

診斷

After VATS biopsy, benign metastasizing leiomyomatosis of the lung was finally diagnosed. The patient had a past history of hysterectomy about 50 years ago for uterine leiomyoma.

VATS活檢後，最終確診為肺良性轉移性平滑肌瘤病。患者約50年前因子宮肌瘤行子宮切除術。

Benign metastasizing leiomyomatosis of the lung

肺良性轉移性平滑肌瘤病

Benign metastasizing leiomyomatosis (BML) is a rare disorder and has been described as originating from a uterine smooth muscle tumor of an unknown malignant potential and may actually represent a heterogeneous group of smooth muscle tumor, ranging from leiomyomas to low grade leiomyosarcomas.

良性轉移性平滑肌瘤病（BML）是一種罕見疾病，為源於未知惡性潛能的子宮平滑肌腫瘤，實際為一組異質性平滑肌腫瘤，從平滑肌瘤到低級別平滑肌肉瘤。

BML refers to numerous well-differentiated leiomyomas at sites distant from uterus that are histologically identical to uterine leiomyoma.

BML指遠離子宮的許多高分化平滑肌瘤，其在組織學上與子宮平滑肌瘤相同。

It is largely accepted that they arise as hematogeneous metastases from benign tumors.

多數人認為是BML由良性腫瘤血行轉移引起的。

BML usually manifests as multiple incidentally detected pulmonary nodules in middle-aged women with a history of hysterectomy for uterine leiomyoma.

BML常見於有子宮肌瘤切除術病史的中年女性，表現為多發偶發肺結節。

The imaging findings are pulmonary nodules, varying from solitary lesions to multiple lesions mimicking pulmonary metastases.

影像學表現為肺結節，從孤立性病變到酷似肺轉移的多個病變。

The nodules may occasionally show cavitation, rarely pneumothorax, or calcification.

結節可能偶爾出現空洞，很少有氣胸或鈣化。

Disease progression is indolent, and symptomatic disease is rare.

疾病呈惰性進展，多無明顯癥狀。

The differential diagnosis is metastases from malignant tumors.

鑒別診斷為惡性腫瘤轉移。

pneumothorax [?nju:m?"θ?:r?ks] n.氣胸

uterine ["ju:t?ra?n] adj.子宮的

well-differentiated adj.高分化的

leiomyomas n.平滑肌瘤;

leiomyosarcomas n. [腫瘤] 平滑肌肉瘤

hematogeneous metastases:血行轉移

感謝So Youn Shin, Dong Wook Sung / Kyung Hee University Hospital