Benign metastasizing leiomyoma (BML) is a rare disease that occurs in middle-aged women with a history of uterine myomas. The most common location of BML is the lungs. We report the case of a 44-year-old obese woman (BMI 45.5) who underwent surgery to remove uterine leiomyomata and then continued to take a drug containing the hormone estradiol for a period of 15 years. Computed tomography chest examinations revealed multiple size nodules of varying size in both lungs. Videothoracoscopy and right thoracotomy was performed, and a few nodules were enucleated from each lobe of the right lung. Postoperative histopathological examination revealed benign metastasizing leiomyoma staining positive for estrogen and progesterone receptors (ER+, PR+). Because of the hormonally dependent cell proliferation, the previously used hormonal drug was discontinued. Treatment with a gonadotropin-releasing hormone analog was included, yielding radiological stabilization of the lung lesions.
Benign metastasizing leiomyoma (BML) to rzadka choroba występująca u kobiet w wieku średnim, które chorowały lub chorują na mięśniaki macicy. Najczęstszą lokalizacją łagodnych przerzutowych mięśniaków (BML) są płuca.W pracy zaprezentowano przypadek 44-letniej otyłej kobiety (BMI 45,5), która przebyła operację usunięcia mięśniaków macicy, a następnie przez 15 lat stosowała lek hormonalny zawierający estradiol. W badaniu tomografii komputerowej klatki piersiowej rozpoznano bardzo liczne guzki różnej wielkości w obu płucach. Wykonano wideotorakoskopię, a następnie torakotomię prawą i wyłuszczono po kilka guzków z każdego płata płuca prawego. W badaniu histologicznym rozpoznano łagodne przerzutowe mięśniaki z dodatnią ekspresją receptorów ER(+) i PR(+). Z uwagi na ich hormonalnie zależny rozrost odstawiono dotychczas stosowany lek hormonalny i włączono leczenie analogiem naturalnego hormonu – gonadoliberyny, uzyskując stabilizację radiologiczną zmian w płucach.

BACKGROUND: Torsion of the uterus is defined as a rotation of more than 45° around the long axis of the uterus; 2/3 of cases are dextrorotations. The extent of rotation usually ranges from 45° to 180°.
OBJECTIVE: The purpose of the article was to present a case study of a postmenopausal woman with uterine torsion and myomas and to review the articles discussing the problem of rotated non-pregnant uterus.
METHODS: The article analyses the course of an extremely uncommon pathology, i.e. uterine torsion in a 67-year-old patient. Laparotomy exposed the uterus with myomas and numerous hemorrhages, rotated by 180° to the right side, size of 350 × 300 × 200 mm and bilateral necrosis of the ovaries. Moreover, we present a review of articles discussing surgical management in case of rotated non-pregnant uterus.
CONCLUSIONS: The patient was operated on by a team of gynecologists and surgeons. The uterus was derotated and total hysterectomy with salpingoophorectomy was performed. A fragment of the hepatic oval ligament was excised and periumbilical hernioplasty was performed. The patient was released home on the 10(th) day following the operation.
CONCLUSIONS: If women complain of pain located within the small pelvis and abdominal cavity it is necessary to remember that it might result from the torsion of reproductive organs which is an uncommon condition but poses a health or life threat to patients. Surgical treatment of uterine torsion is successful if promptly implemented; in certain cases it is even possible to spare the patient\'s fertility.