Perioperative transcatheter embolisation of a locally recurrent metastatic uterine leiomyoma

Abstract

representing extra-uterine foci of leiomyomatous lesions of variable size and locations and variable delay in presentation after initial diagnosis of uterine fibroids. The nature of benign metastasizing leiomyoma has been debated since it was first reported in 1939, and only a few dozen cases have been reported in the English literature 1 . Recent findings at the proteomic and genomic level demonstrate that the metastatic lesions are clonally related to the primary uterine fibroids and suggest that their pathogenesis relies on metastatic spread and not on simultaneous multifocal appearance 2 . Therefore, these tumours could be regarded as borderline tumours or tumours with low malignant potential. Due to the rarity of these cases, there is currently no consensus on their management. The high expression of oestrogen (ER) and progesterone (PR) receptors supports the use of hormonal therapy. Surgical intervention can be challenging due to the recurrent, often disseminated nature of these tumours and their aberrant vascularity. Over the last few decades, uterine artery embolisation has emerged as an established treatment for primary uterine fibroids. This case suggests that angiography and embolisation should be considered in the management of the patients with BML in an attempt to avoid surgical intervention or decrease the risk for perioperative bleeding.