A Case of Benign Metastasizing Leiomyoma Diagnosed 10 Years After Hysterectomy

背景.良性転移性平滑筋腫 (benign metastasizing leiomyoma, 以下BML) は異型性がほとんどない平滑筋腫が肺に出現するまれな疾患である. 多くは子宮全摘術の既往を認めるが, その病態は未だ明らかではない. 我々は子宮筋腫術後10年目に発見されたBMLの1例を経験し, 肺結節と子宮筋腫の組織を用いた免疫組織化学的検討を行ったので報告する. 症例. 53歳, 女性. 胸部異常陰影の精査のため, 当院を紹介された. 両肺に径3～18mmの多発結節影を認め, 転移性肺癌の疑いで胸腔鏡下肺生検を施行し, BMLと診断した. その病態を考察する目的でestrogen receptor (ER), progesterone receptor (PgR), P53, Bcl-2, Ki-67の免疫染色を行ったところ, ER, PgR, Bcl-2陽性, P53, Ki-67陰性と肺結節, 子宮筋腫両者の組織で同じ染色パターンを呈した. 結論. 本症例では肺結節, 子宮筋腫は組織学的に同様の所見を呈し, いずれもER, PgR陽性であり, 性ホルモンの関与が推測された. BMLはまれな疾患であるが, 肺多発結節影の鑑別診断の1つとして考慮する必要がある.

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