Endolymphatic stromal myosis with pulmonary metastases. Remission with progestin therapy: report of a case

A case of endolymphatic stromal myosia with pulmonary metastases its remission apparently resulting from progestin therapy is described. This type of tumor is reported in only .2% of all uterine cancers. The course of these tumors is variable and unpredictable; they are often given other names-stromal endometriosis proliferative stromatosis and endometriosis interstitial among others. Of 50 reported cases 6% had metastatic lesions in the lungs with 8% having metastases elsewhere. Late metastatic lesions have been reported as late as 26 years after hysterectomy. A Mullerian origin is is believed. Success of others in treating similar cases with progestational therapy suggested such treatment in this case. The patient was a 44-year-old white female. Her last pregnancy in 1964 was complicated by a pulmonary embolus without evidence of phlebitis. She had a section delivery while on heparin therapy. Bilateral tubal ligation was done. In 1967 following a curettage for irregular vaginal bleeding submucous leiomyomas cervicitis and a proliferative endometrium were diagnosed. She continued to have irregular bleeding. After another curettage forcal stromal hyperplasia was diagnosed and a hysterectomy was done. Pathological diagnosis of the removed tissue was endolymphatic stromal myosis with invasion of the myometrium and lymphatics. In 1969 x-rays showed scattered metastatic nodules in the right lung. After a total dose of 5 gms of 17-alpha-hydroxy-progesterone caproate over 2 and a half weeks there was regression of the metastases. The drug was continued 1 gm weekly until side effects caused the patient to refuse further treatment. In 1970 the pulmonary nodules appeared more prominent. Medroxy-progesterone acetate 400 mg per ml was given 1 gm weekly. Later dosage was reduced temporarily to .4 gm weekly. Finally in 1971 the dose was reduced to 2 and then by 1972 1 gm a month. X-rays in 1972 showed no lung metastasis. Physical examinations revealed no recurrence elsewhere. The patient remains in good health. It is recommended that these tumors with metastases be treated with a high dosage progestin prior to starting radiation chemotherapeutic agents or surgery.