A Woman with a Lung Mass and Multiple Pulmonary Nodules

BACKGROUND: Patients presenting with lung mass and/or nodules are common problems for pulmonologists. The common etiologies for this condition in this area (Ohio River Mississippi Valley area) are malignancy, histoplasmosis, and sarcoidosis. However, there can be other rare causes of this presentation for which a detailed clinical history, examination, and broad knowledge is needed for diagnosis.
CASE REPORT: A 41-year-old woman presented with complaints of progressive nonproductive cough, shortness of breath, and decreased exercise limitation for several months. The symptoms were progressive and were hindering her daily work. Physical examination, including vital signs, was within normal limits. A chest X-ray followed by CT chest was done. CT chest showed a right infrahilar mass 3.5×2.5 cm along with multiple bilateral lung nodules of size 9 to 11 mm. Bronchoscopy with transbronchial needle aspiration (TBNA) and transbronchial biopsy (TBB) and CT-guided biopsy failed to show any diagnosis. Repeat CT scan at follow-up showed the same lesion and the patient had an open-lung biopsy. A diagnosis of benign metastasizing leiomyoma (BML) was made based on clinical, radiological, and histological features, and immunophenotype of the lesion. The patient was started on leuprolide (a GnRH agonist). Follow-up imaging showed decrease in size of lesions. The patient is asymptomatic with increased exercise tolerance.
CONCLUSIONS: Clinicians need to be aware of rare causes of lung mass, like BML. This will help in timely diagnosis and treatment.

Keywords: Bronchoscopy, Biopsy, Adult, Diagnosis, Differential, Leiomyoma - diagnosis, Lung Neoplasms - diagnosis, Multiple Pulmonary Nodules - diagnosis, Tomography, X-Ray Computed