Pathogenesis of Benign Metastasizing Leiomyoma

Awoniyi O. Awonuga, Awonuga AO, Shavell VI, Valerie I. Shavell, Anthony N. Imudia, Imudia AN, Michael Rotas, Rotas M, Michael P. Diamond, Puscheck EE, Elizabeth E. Puscheck
Obstetrical & gynecological survey · 2010 · vol. 65(3) , pp. 189–195 · doi:10.1097/ogx.0b013e3181d60f93 · PMID:20214834 · W2067295087
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This review of benign metastasizing leiomyoma literature explores its possible etiologies, suggesting similarities with endometriosis, and emphasizes differentiating it from leiomyosarcoma.

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This review examines the pathogenesis of benign metastasizing leiomyoma, a rare condition where uterine smooth muscle tumors spread to extrauterine sites. The authors analyze literature suggesting mechanisms such as lymphatic or hematogenous spread and coelomic metaplasia, noting that these processes closely mirror those proposed for endometriosis. A key limitation highlighted is the necessity for meticulous pathological sampling to distinguish this benign entity from aggressive leiomyosarcoma. Relevance to endometriosis: the paper explicitly explores the similarities between the pathogenesis of benign metastasizing leiomyoma and endometriosis, stating that the mechanisms explaining one can also explain the other.

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Abstract

UNLABELLED: Uterine leiomyomas are benign tumors of smooth muscle origin with protean symptomatology, and are the most common gynecological tumor in women of reproductive age. Very rarely, benign uterine leiomyomas display bizarre growth patterns with associated extrauterine benign-appearing smooth muscle tumors, similar to the smooth muscle cells found in a uterine fibroid, and are given the name benign metastasizing leiomyoma (BML). We reviewed the published literature to outline the possible etiology of benign metastasizing leiomyoma (BML), and explored the similarities between BML and endometriosis. Several observations and animal experiments support the findings that BML may evolve from lymphatic and hematological spread, coelomic metaplasia and intraperitoneal seeding. The weight of available evidence support the conclusion that the mechanism used to explain the pathogenesis of endometriosis can also be used to explain BML. However, in making a diagnosis of BML, meticulous sampling of the pathology specimen should be undertaken to exclude leiomyosarcoma, which unlike BML, has an aggressive course. It is hoped that analyses of the etiology and features of this disorder will facilitate a better understanding of its pathogenesis and treatment. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to asses the clinical characteristics of Benign Metastasizing Leiomyoma. Compare the potential pathophysiology with endometriosis and differentiate benign metastasizing Leiomyoma from Leiomyosarcoma.
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Pathogenesis of Benign Metastasizing Leiomyoma A Review - Awoniyi O. Awonuga - Valerie I. Shavell - Anthony N. Imudia - Michael Rotas - Michael P. Diamond - Elizabeth E. Puscheck Uterine leiomyomas are benign tumors of smooth muscle origin with protean symptomatology, and are the most common gynecological tumor in women of reproductive age. Very rarely, benign uterine leiomyomas display bizarre growth patterns with associated extrauterine benign-appearing smooth muscle tumors, similar to the smooth muscle cells found in a uterine fibroid, and are given the name benign metastasizing leiomyoma (BML). We reviewed the published literature to outline the possible etiology of benign metastasizing leiomyoma (BML), and explored the similarities between BML and endometriosis. Several observations and animal experiments support the findings that BML may evolve from lymphatic and hematological spread, coelomic metaplasia and intraperitoneal seeding. The weight of available evidence support the conclusion that the mechanism used to explain the pathogenesis of endometriosis can also be used to explain BML. However, in making a diagnosis of BML, meticulous sampling of the pathology specimen should be undertaken to exclude leiomyosarcoma, which unlike BML, has an aggressive course. It is hoped that analyses of the etiology and features of this disorder will facilitate a better understanding of its pathogenesis and treatment. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to asses the clinical characteristics of Benign Metastasizing Leiomyoma. Compare the potential pathophysiology with endometriosis and differentiate benign metastasizing Leiomyoma from Leiomyosarcoma.

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Condition tags

endometriosis

MeSH descriptors

Leiomyoma Uterine Neoplasms Animals Diagnosis, Differential Endometriosis Endometriosis Female Humans Leiomyoma Leiomyoma Leiomyoma Leiomyosarcoma Leiomyosarcoma Leiomyosarcoma Mice Uterine Neoplasms Uterine Neoplasms Uterine Neoplasms

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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