rare disorders such as BML require a multidisciplinary approach. highlights the importance of exploring lung bases in CTAP when querying malignant spread from a gynaecological malignancy. think of multiple synchronous pathologies when dealing with rare entities, where the radiological features do not clinically correlate with the patient’s presentation.

Uterine leiomyomas are the most commonly reported benign gynaecological smooth muscle tumour afflicting women of reproductive age.1 Women who underwent primary surgery such as a hysterectomy at the mean age of 38.5 years were subsequently diagnosed with BML featuring pulmonary metastases at a mean age of 47.3 years.2 Monoclonal spread and peritoneal seeding from fragments post-surgery are the current prevailing theories underlying the pathogenesis of BML.1-3 Microscopically, BML demonstrates smooth muscle cell differentiation with immunohistochemistry revealing mild tumour cell proliferation.1-3 Patients diagnosed with BML undergo...

A 55‐year‐old female presented with menorrhagia for 4 weeks. Dilation and curettage suggested grade 1 endometrial cancer. Computed tomography (CT) of the abdomen and pelvis did not demonstrate abdominopelvic nodes, but multiple lesions in the lung bases. The patient was planned for a CT-guided biopsy of the presumed lung metastases. However, the non-contrast planning CT chest revealed a large well-circumscribed anterior mediastinal soft tissue mass with central calcifications, which was not captured on the CTAP. Following the biopsy, the PET scan revealed diffuse uptake in...

The pulmonary BML remained stable three months post biopsy. She will undergo progesterone therapy for the uterine adenocarcinoma with the possibility of hysterectomy if lung burden increases. This will be supplemented by monitoring for the mediastinal mass. Managing an already rare disorder such as BML pose clinical conundrums and decision-making dilemmas. When this is compounded by an atypical presentation, initial diagnoses can be deceiving and requires a multidisciplinary approach that can delve into other diagnostic/management algorithms. Our atypical presentation of BML serves as a clinical...

[1] Awonuga AO, Shavell VI, Imudia AN, Rotas M, Diamond MP, Puscheck EE. Pathogenesis of benign metastasizing leiomyoma: a review. Obstetrical & gynecological survey. 2010 Mar 1;65(3):189-95. [2] Barnaś E, Książek M, Raś R, Skręt A, Skręt-Magierło J, Dmoch-Gajzlerska E. Benign metastasizing leiomyoma: a review of current literature in respect to the time and type of previous gynecological surgery. PLoS One. 2017 Apr 20;12(4):e0175875. [3] Joo HJ, Han SS, Kwon JT, Park ES, Jung YY, Kim HK. Epidural intracranial metastasis from benign leiomyoma: a case...