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Case Reports
. 2014 Oct-Dec;10(4):251-4.
doi: 10.14797/mdcj-10-4-251.

Metastasizing leiomyoma to heart

Erin N Consamus  1 , Michael J Reardon  1 , Alberto G Ayala  1 , Mary R Schwartz  1 , Jae Y Ro  1
Affiliations
Case Reports

Metastasizing leiomyoma to heart

Erin N Consamus et al. Methodist Debakey Cardiovasc J. 2014 Oct-Dec.

Abstract

Cardiac smooth muscle tumors are rare. Three different clinical settings for these tumors have been reported, including benign metastasizing leiomyoma from the uterus, primary cardiac leiomyoma and leiomyosarcoma, and intravenous cardiac extension of pelvic leiomyoma, which is the most common. We present a case of a 55-year-old woman with a benign metastasizing leiomyoma to the heart 17 years after hysterectomy and 16 years after metastasis to the lung. Immunohistochemical stains for smooth muscle actin, desmin, and estrogen and progesterone receptors were positive, indicating a smooth muscle tumor of uterine origin. To our knowledge, this is only the fourth reported case of benign metastasizing leiomyoma to the heart and the first case of long-delayed cardiac metastasis after successful treatment of pulmonary metastasis. It illustrates that benign metastasizing leiomyoma should be included in the differential diagnosis of cardiac tumors in patients with a history of uterine leiomyoma, especially when associated with pulmonary metastasis.

Keywords: benign metastasizing leiomyoma; heart; primary cardiac tumor.

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Figures

None
E. N. Consamus, M.D.
Figure 1.
Figure 1.
Magnetic resonance imaging showing a bilobed, pedunculated, mobile, well-circumscribed mass attached to the intra-atrial septum.
Figure 2.
Figure 2.
The 4-cm resected cardiac tumor was solid, gray-white, and homogeneous with no hemorrhage or necrosis.
Figure 3.
Figure 3.
(A) The tumor is composed of bundles of bland spindle cells with “cigar-shaped nuclei,” no nuclear atypia or necrosis, and only rare mitoses (less than 1/10 highpower fields: hematoxylin and eosin stain). (B) The tumor cells were diffusely strongly positive for smooth muscle actin and (C) estrogen receptor and were focally weakly positive for progesterone receptor (not illustrated), which is supportive of uterine origin.
See this image and copyright information in PMC

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