EFFICACY OF ANTIESTROGEN TREATMENT IN A BENIGN METASTASIZING LEIOMYOMA WITH PARANEOPLASTIC ESTRADIOL PRODUCTION

Benign metastasizing leiomyoma (BML) is a rare hormone-dependent disea se which occurs predominantly in women during their child-bearing year s. After our patient had refused ablative hormone therapy (bilateral o varectomy), evidence of estrogen and progesteron receptors in tumor ti ssue taken from the lung sites, as well as extremely high estradiol se rum levels, led us to conduct high-dosage antiestrogen therapy for 5 y ears; daily administration of 250 mg of Tamoxpuren(R) resulted in stab le disease of the pulmonary sites without any side effects. This also significantly lowered estradiol serum levels, which improved clinical symptoms. Five years later, the patient's vision suddenly deteriorated due to bilateral macula degeneration. This forced us to stop the anti estrogen therapy and commence alternative treatment with LHRH analogue (3.6 mg Goreselin). We observed stable disease of the pulmonary metas tases and low estradiol serum levels during the first 6 months of Gose relin treatment. The response to antiestrogen therapy in BML suggests that the muscular component of these disorders is responsive to estrog en ablation.