Hormonal manipulation of benign metastasizing leiomyomas: report of two cases and review of the literature.
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.
Rivera
J A
JA
Royal Victoria Hospital, 687 Pine Avenue West, Room M3.15, Montréal, Québec H3A 1A1, Canada. juan.rivera@mcgill.ca
Christopoulos
S
S
Small
D
D
Trifiro
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M
D000328:Adult; D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy; D009570:Nitriles / Q000627:therapeutic use; D013902:Radiography, Thoracic; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014594:Uterine Neoplasms / Q000473:pathology*
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D020847:Estrogen Receptor Modulators; D009570:Nitriles; D020845:Selective Estrogen Receptor Modulators; D014230:Triazoles; D000077384:Anastrozole; D007987:Gonadotropin-Releasing Hormone; D020849:Raloxifene Hydrochloride