PMC8205596_01
Initial CT scan at the time of motor vehicle accident in November 2019 (a) shows multiple pulmonary nodules the largest measuring 1.2 cm (white arrow) in the anterior right lower lobe (RLL). The blue arrow in the CT scan shows the top of the liver. In March 2020, CT scan of the chest (b) showed the dominant RLL lesion now measuring 2.0 cm depicted with the thicker arrow and a new smaller posterior RLL nodule depicted with the thinner arrow. After starting tamoxifen, the CT scan of the chest in November 2020 (c) shows stability of the dominant anterior RLL measuring 1.8 cm and the posterior RLL nodule is improving. (d) Is the sagittal image of the chest CT in March 2020 revealing the sternum mass that measured 5.7 x 3 cm with invasion into the cortex of the bone causing destruction of the bone.
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While undergoing routine X-rays and Computed Tomography (CT) scans of her chest, abdomen, and pelvis, she was found to have multiple pulmonary nodules in both lungs, largest in the right lower lobe measuring 1.2 cm (Figure 1(a)). We repeated a chest CT which showed new bilateral lung nodules, and the largest right lower lobe nodule now measured 2 cm (Figure 1(b)). The mass in her manubrium increased to 5.7 x 3.0 cm and was invading into the cortex of the bone (Figure 1(d)). She was initiated on tamoxifen, and after three months, a repeat chest CT showed stability of the size and number of the lung nodules as well as stability of her sternum mass (Figure 1(c)).
Lung biopsy H&E stain (a) shows a spindle cell neoplasm with no atypia, necrosis, or increased mitoses that is positive for smooth muscle actin (b). The sternum biopsy (c) also histologically resembles the lung biopsy and shows a spindle cell neoplasm that did not have any malignant features. The sternum biopsy is positive for estrogen receptors (d) and progesterone as well. Since no malignant features were seen in either biopsy and given history of leiomyoma, a diagnosis of benign metastasizing leiomyoma was given.
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After a second consultation, it was confirmed as BML with no evidence of malignant sarcoma (Figure 2).