Localized retroperitoneal lymphangioleiomyomatosis mimicking malignancy

A case report and review of the literature

Vilkesh R. Jaiswal, Julie Baird, Jason Fleming, David Scott Miller, Suash Sharma, Kyle Molberg

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Lymphangioleiomyomatosis (lymphangiomyomatosis [LAM]), a rare disease of unknown etiology that is seen only in women usually in the reproductive period, generally presents with features of pulmonary involvement. Extrapulmonary involvement, such as angiomyolipomas and retroperitoneal adenopathy, can occur in up to 75% of cases. It is very rare, however, for patients to present with features of extrapulmonary LAM. We present an unusual, localized case of LAM presenting with neurologic symptoms related to a retroperitoneal mass in a 51-year-old woman. Magnetic resonance imaging showed that the mass involved retroperitoneal lymph nodes, and a clinical diagnosis of atypical sarcoma (possibly from a uterine primary) was made. The mass was resected, and a total abdominal hysterectomy was performed. On pathologic examination, the mass showed classic histologic features of LAM with spread along lymphatic channels in the lymph nodes. Intralymphatic projections simulated lymphatic metastasis; however, the cytologic features were benign. Immunostains revealed the tumor to be positive for smooth muscle actin and desmin, but negative for HMB-45. The uterus was unremarkable, except for a subserosal leiomyoma. Although intratumoral variability for HMB-45 has recently been described, to the best of our knowledge, this is the first documented case of HMB-45-negative, histologically classic LAM. Because of the presence of several atypical features in this case, such as age, location, compressive neurologic presentation, radiologic impression of atypical sarcoma, and HMB-45 negativity, we feel that this case may represent a distinct, as yet uncharacterized variant of LAM.

Original languageEnglish (US)
Pages (from-to)879-882
Number of pages4
JournalArchives of Pathology and Laboratory Medicine
Volume127
Issue number7
StatePublished - Jul 1 2003
Externally publishedYes

Fingerprint

Lymphangioleiomyomatosis
Neoplasms
Sarcoma
Lymph Nodes
Lymphatic Metastasis
Angiomyolipoma
Desmin
Leiomyoma
Rare Diseases
Neurologic Manifestations
Hysterectomy
Nervous System
Uterus
Reproduction
Smooth Muscle
Actins
Magnetic Resonance Imaging
Lung

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Localized retroperitoneal lymphangioleiomyomatosis mimicking malignancy : A case report and review of the literature. / Jaiswal, Vilkesh R.; Baird, Julie; Fleming, Jason; Miller, David Scott; Sharma, Suash; Molberg, Kyle.

In: Archives of Pathology and Laboratory Medicine, Vol. 127, No. 7, 01.07.2003, p. 879-882.

Research output: Contribution to journalArticle

Jaiswal, Vilkesh R. ; Baird, Julie ; Fleming, Jason ; Miller, David Scott ; Sharma, Suash ; Molberg, Kyle. / Localized retroperitoneal lymphangioleiomyomatosis mimicking malignancy : A case report and review of the literature. In: Archives of Pathology and Laboratory Medicine. 2003 ; Vol. 127, No. 7. pp. 879-882.
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