Clinical Characteristics and Diagnostic-Therapeutic Analysis of Pulmonary Benign Metastasizing Leiomyoma: A 10-Case Retrospective Study and Systematic Review

BackgroundPulmonary benign metastasizing leiomyoma (PBML), characterized by histologically benign lung metastases from uterine leiomyomas, represents a rare hormone-dependent entity with enigmatic pathogenesis. The aim of the study was to define the clinical-radiological features and therapeutic management of pulmonary benign metastasizing leiomyoma.MethodsA total of 115 cases of PBML in women were reviewed, including 105 cases selected from PubMed and 10 cases treated at our institution from 2014 to 2025. Data encompassed clinical history, imaging findings, pathological diagnosis, treatments, and follow-up outcomes. A comprehensive literature review was undertaken. No prospective interventions were performed.ResultsA systematic review identified 105 published PBML cases. Combined with our institutional cohort (n = 10), analysis of 115 patients revealed a median age of 46 years, with bilateral pulmonary nodules present in 68.7% of cases and a history of uterine surgery in 92.1%. Immunohistochemistry consistently showed positivity for smooth muscle markers (90%), estrogen receptor (86.3%), and progesterone receptor (88.2%). Surgical resection of pulmonary lesions was performed in 42.6% (49/115) of patients and was associated with a favorable prognosis, with 85.2% (41/48) of surgically managed patients achieving disease-free status during follow-up.ConclusionPulmonary benign metastasizing leiomyoma is a rare hormone-dependent neoplasm linked to uterine leiomyoma. Pathological verification remains essential for diagnosis. Surgical resection may correlate with favorable outcomes, necessitating long-term recurrence surveillance.