Reviewer’s report
Title: 
Benign metastasizing uterine leiomyoma with lymphatic and pulmonary
metastases-a case report and literature review
Version: 
2 
Date: 
18 Jan 2023
Reviewer's report:
This case report is interesting and well documented. However, I believe that it is
not well discussed nor is the literature well reviewed. Pulmonary
Lymphangioleiomyomatosis (LLM) is not mentioned (this word is only in
citation 27) nor is the differential diagnosis between pulmonary LLM,
intravenous leiomyomatosis, or benign metatasizing leiomyoma analyzed. Nor is
the behavior or the most appropriate treatment discussed in these cases. We had
a 46-year-old patient with dyspnea and periodic catamanial memoptysis who, at
44, had been diagnosed with pulmonary MLL by biopsy after pneumothorax and
hemoptysis. At the age of 45 she had undergone a multiple Myomectomy by
laparotomy; and that now at 46 years old with recurring symptoms and multiple
myomas she was referred to us. The patient improved and did very well with
treatment under GnRH analogues and Tibolone (as add back therapy). After a
Total Hysterectomy with double adnexectomy, she has continued very well with
Tibolona as hormone replacement therapy for menopause (this case is described
in the Gynecology Book: Acién P. Tratado de Obstetricia y Ginecología -
GINECOLOGIA-Ediciones Molloy, 2004, cap 28, p1108-9)
Other references to consider: Mavroudi-2013 (J Thorac Dis 2013;5(1):74-79);
Mantilla-2022 (Practical Lung Pathology, Xu et al, Springer, cap 58, p349 and
357). Lazzari et al, 2017; McCormack et al, 2012; Ki et al, 2013; Taveira
DaSilva et al, 2012..
Many references are incorrectly cited and there is no uniformity. See 12, 13, 14,
15..17. Neither are those included in Table 1, which I believe are not applicable.
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