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Chen J, Bu H, Zhang Z, Chu R, Qi G, Zhao C, Wang Q, Ma X, Wu H, Dou Z, Wang X, Kong B. Clinical features and prognostic factors analysis of intravenous leiomyomatosis. Front Surg 2023; 9:1020004. [PMID: 36793517 PMCID: PMC9922872 DOI: 10.3389/fsurg.2022.1020004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023] Open
Abstract
Background The treatment and prognostic factors of intravenous leiomyomatosis (IVL) remain lacking systematic evidence. Methods A retrospective study was conducted on IVL patients from the Qilu Hospital of Shandong University, and IVL cases were published in PubMed, MEDLINE, Embase and Cochrane Library databases. Descriptive statistics were used for the basic characteristics of patients. The Cox proportional hazards regression analysis was used to assess the high-risk factors related to the progression-free survival (PFS). The comparison of survival curves was performed by Kaplan-Meier analysis. Results A total of 361 IVL patients were included in this study, 38 patients from Qilu Hospital of Shandong University, and 323 patients from the published literature. Age ≤45 years was observed in 173 (47.9%) patients. According to the clinical staging criteria, stage I/II was observed in 125 (34.6%) patients, and stage III/IV was observed in 221 (61.2%) patients. Dyspnea, orthopnea, and cough were observed in 108 (29.9%) patients. Completed tumor resection was observed in 216 (59.8%) patients, and uncompleted tumor resection was observed in 58 (16.1%) patients. Median follow-up period was 12 months (range 0-194 months), and 68 (18.8%) recurrences or deaths were identified. The adjusted multivariable Cox proportional hazard analysis showed age ≤45 years (vs. >45) (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.15-3.80, p = 0.016), and uncompleted tumor resection (vs. completed tumor resection) (HR = 22.03, 95% CI 8.31-58.36, p < 0.001) were high-risk factors related to the PFS. Conclusion Patients with IVL have a high probability of recurrence after surgery and a poor prognosis. Patients younger than 45 years and with uncompleted tumor resection are at higher risk of postoperative recurrence or death.
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Affiliation(s)
- Jingying Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaoyang Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Qiuman Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyue Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Huan Wu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiyuan Dou
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Xia Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Xia Wang Beihua Kong
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Xia Wang Beihua Kong
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2
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Akinseye OA, Nayyar M, Das P. Uterine intravenous leiomyomatosis with femoral vein, intracaval, intracardiac and pulmonary artery extension. Future Cardiol 2019; 16:27-32. [PMID: 31766884 DOI: 10.2217/fca-2019-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a 54-year-old female with recently diagnosed multiple cardiac thrombi and pulmonary embolism that was treated with thrombolytics and anticoagulants. She presented again with worsening dyspnea and was found to have persistent large cardiac thrombi on echocardiogram. Surgical findings revealed a single right atrial mass originating from inferior vena cava and extending into the pulmonary artery. The mass was successfully removed. Final pathology revealed a benign smooth muscle and vascular mass with estrogen and progesterone receptor positivity favoring uterine intravenous leiomyoma. She was discharged on warfarin and leuprolide therapy. This diagnosis requires a high index of suspicion, especially in a middle-aged woman with right atrial mass and history of an existing leiomyoma, hysterectomy or myomectomy.
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Affiliation(s)
- Oluwaseun A Akinseye
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Mannu Nayyar
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Pranab Das
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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3
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Devereaux KA, Schoolmeester JK. Smooth Muscle Tumors of the Female Genital Tract. Surg Pathol Clin 2019; 12:397-455. [DOI: 10.1016/j.path.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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4
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Barnaś E, Raś R, Skręt-Magierło J, Wesecki M, Filipowska J, Książek M, Skręt A, Widenka K. Natural history of leiomyomas beyond the uterus. Medicine (Baltimore) 2019; 98:e15877. [PMID: 31232922 PMCID: PMC6636938 DOI: 10.1097/md.0000000000015877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Most leiomyomas are located in the uterus. Leiomyomas are rarely found outside the uterus and classified as leiomyoma beyond the uterus (LBU). This group consists of disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, intravenous leiomyomatosis, parasite leiomyoma located in the broad ligament and retroperitoneal space. The descriptions of the patients who suffer from these types of leiomyomas are presented mainly in case reports. PATIENT CONCERNS A 34-year-old multiparous woman was operated on multiple recurrent uterine leiomyoma in parametrium. At one time, 32 leiomyomas were removed. Thirteen months following it, in next laparotomy, 132 leiomyomas were excised. Histologically, both were intravenous leiomyomas (IVLs). DIAGNOSIS AND INTERVENTIONS In follow-up, computed tomography (CT) and magnetic resonance imaging scans were performed to look for next recurrent leiomyoma. Accidentally, the mass was found in inferior vena cava which was diagnosed as intravenous vena cava leiomyoma. The mass was removed and the final diagnosis of intravenous myoma was confirmed in histopathology. OUTCOMES CT scan performed 3 months after the surgery for leiomyoma in vena cava revealed no pathology. Next 10 months' follow-up was uneventful. LESSONS The recurrent multiple uterine leiomyoma precede LBU. The uterine leiomyoma spreads intravenously route to parametria as parasite leiomyoma, then to vena cava. It has to be taken into account in follow-up.
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Affiliation(s)
| | - Renata Raś
- Department of Physics, Rzeszow University of Technology
| | | | - Mariusz Wesecki
- Oncology Surgery Department, Specialist Hospital in Brzozów, Podkarpacki Oncological Center, Brzozów
| | - Justyna Filipowska
- Chair of Electroradiology, Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszow
| | - Mariusz Książek
- Clinical Department of Pathology, Frederick Chopin Clinical Provincial Hospital No 1
| | - Andrzej Skręt
- Obstetrics and Gynecology Clinic, Medical Faculty, University of Rzeszow, Rzeszow
| | - Kazimierz Widenka
- Clinical Department of Cardiac Surgery, Medical Faculty, University of Rzeszów, Rzeszów, Poland
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Atalay A, Poyrazoglu HH, Göçen U, Yüksel M, Eray IC, Guzel AB, Gok M. Successful One Stage Surgical Removal of Intravenous Leiomyomatosis with On Pump Beating Heart Technique. Heart Lung Circ 2016; 25:e72-4. [DOI: 10.1016/j.hlc.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/31/2015] [Accepted: 11/03/2015] [Indexed: 11/24/2022]
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6
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Abstract
A 48-year-old woman presented with a 2-month history of right lower extremity edema. Clinical examination only showed right lower limb swelling. Routine laboratory examination revealed no abnormal results. Abdominal ultrasonography identified uterine leiomyoma and soft tissue masses. An abdominal CT demonstrated a continuous mass extending from the right internal and external iliac vein into the common iliac vein and inferior vena cava. To distinguish the mass from malignancy, the patient underwent PET/CT scan which showed increased FDG activity in the mass. However, histopathological examination proved the mass to be IV leiomyomatosis.
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Baboci A, Prifti E, Xhabija N, Alimehmeti M. Surgical removal of an intravenous leiomyoma with intracardiac extension and pulmonary benign metastases. Heart Lung Circ 2013; 23:174-6. [PMID: 24200983 DOI: 10.1016/j.hlc.2013.10.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/09/2013] [Indexed: 11/15/2022]
Abstract
Intravenous leiomyomatosis (IVL) with right intracardiac extension or pulmonary benign metastases (PBM) is rare. We report a case of 51 year-old woman, who underwent successful extensive double stage surgical removal of the intracardiac IVL extension associated with a pulmonary limited resection where the cystic bullae and PBM were found, and a month later gynaecological operation. To our knowledge this is the first reported case of such a combination.
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Affiliation(s)
- Arben Baboci
- Division of Cardiac Surgery, Medical University of Tirana, Albania
| | - Edvin Prifti
- Division of Cardiac Surgery, Medical University of Tirana, Albania.
| | - Nereida Xhabija
- Division of Cardiac Surgery, Medical University of Tirana, Albania
| | - Mehdi Alimehmeti
- Division of Cardiac Surgery, Medical University of Tirana, Albania
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8
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Leiomiomatose intravenosa: do útero ao coração. ANGIOLOGIA E CIRURGIA VASCULAR 2013. [DOI: 10.1016/s1646-706x(13)70014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Clay TD, Dimitriou J, McNally OM, Russell PA, Newcomb AE, Wilson AM. Intravenous leiomyomatosis with intracardiac extension - a review of diagnosis and management with an illustrative case. Surg Oncol 2013; 22:e44-52. [PMID: 23642379 DOI: 10.1016/j.suronc.2013.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/05/2013] [Accepted: 03/27/2013] [Indexed: 12/01/2022]
Abstract
Intravenous leiomyomatosis with intracardiac extension is an uncommon pathologic progression of uterine leiomyomata. It is a histologically benign condition, however due to interfence with right sided cardiac function patients may present with marked cardiovascular compromise and present a diagnostic dilemma to clinicians who are unfamiliar with this condition. Given the rarity of this condition, experience in individual institutions is usually limited to a few cases. We present an illustrative case and provide a review of the clinical presentation, preoperative assessment, operative approach, pathology and postoperative issues. The importance of a multidisciplinary approach to diagnosis and management is highlighted. Operative management aims to completely resect all tumour in the safest manner for the patient, most commonly via single or two stage operation. Where complete resection is achieved, recurrence appears to be a rare event.
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Affiliation(s)
- Timothy D Clay
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia.
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10
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Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein. Fertil Steril 2012; 98:1341-5.e1. [DOI: 10.1016/j.fertnstert.2012.07.1121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 07/14/2012] [Accepted: 07/16/2012] [Indexed: 11/18/2022]
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11
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Gan HL, Zhang JQ, Zhou QW, Kong QY, Zhao S, Bo P. Surgical treatment of intracardiac leiomyomatosis. J Thorac Cardiovasc Surg 2011; 142:823-8. [DOI: 10.1016/j.jtcvs.2011.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 12/17/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
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12
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Guo X, Zhang C, Fang L, Guo L, Zhu W, Fang Q, Chen G, Miao Q, Sun J. Echocardiographic characteristics of intravenous leiomyomatosis with intracardiac extension: a single-institution experience. Echocardiography 2011; 28:934-40. [PMID: 21854425 DOI: 10.1111/j.1540-8175.2011.01472.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Intravenous leiomyomatosis (IVL) is a rare smooth-muscle proliferation arising from a uterine myoma and occasionally extending into cardiac chambers. METHODS AND RESULTS A series of 10 consecutive patients with histologically and surgically proven intracardiac IVL between 2000 and 2010 in our hospital were reviewed. The echocardiographic features of 10 cases with IVL and extensive spread into the right-sided cardiac chambers were described for the first time. All patients were female and the mean age was 42±7 years old. The first symptoms of six patients (60%) were exertional dyspnea and palpitation of cardiac origin. Echocardiography showed that all the tumors originated from the inferior vena cava (IVC) and located in cardiac right chambers (70% in right atrium alone, 30% in right ventricle and atrium). Eight masses (80%) were oval, whereas the others (20%) were serpentine, all with well-demarcated borders and most (70%) with heteroechogenic texture. Five tumors (50%) intermittently prolapsed into right ventricle through the tricuspid valve. Two patients with nodules adhering to the top of the tumors had pulmonary tumorous thromboembolism. CONCLUSION Echocardiography is a simple and important technique to diagnose IVL with intracardiac extension. This disease should be considered in a female patient presenting with an extensive mass from IVC with well-demarcated border in the right-sided cardiac chambers.
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Affiliation(s)
- Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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13
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Abstract
BACKGROUND There is a great deal of heterogeneity in the surgical strategy to treat intracardiac leiomyomatosis (ICL), leading to a need to create a theoretical tool to clarify this situation. METHODS The data of 14 cases of ICL surgically treated in Anzhen Hospital from February 1995 to February 2009 were retrospectively reviewed. A system for classifying ICL was proposed based on four features of the lesion: size of intracardiac component; extent of inferior vena cava (IVC) involvement; venous pathway from uterus to IVC; and laterality of the lesion in the pelvis. The 14 cases of ICL were treated through multiple surgical strategies. RESULTS There were no operative deaths. The follow-up was 73.1 +/- 59.2 months and one patient died from recurrence due to incomplete excision 5 months after the primary procedure. The 5-year survival rate calculated through Kaplan-Meier survival curve was 93.16 +/- 4.98%. Of the surviving patients, 13 had ICL, 10 were in the New York Heart Association (NYHA) class I, and three were in NYHA class II. CONCLUSION The surgical treatment of ICL can obtain a good mid- to long-term survival rate and satisfactory heart function, and the proposed classification system for ICL may be helpful to guide the selection of the surgical strategy for ICL, and may serve as the future basis for standardising the reporting of ICL management.
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14
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Derubertis BG, Clair D, Faries P, Kapur S, Park K, Kent KC. Resection of an intravenous leiomyoma with intracardiac extension with use of endovascular techniques. J Vasc Surg 2004; 40:554-8. [PMID: 15337888 DOI: 10.1016/j.jvs.2004.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intravenous leiomyoma with intracardiac extension is a rare entity that necessitates surgical excision to alleviate symptoms and prevent life-threatening complications. These procedures are generally performed under cardiopulmonary bypass, and review of the literature reveals an evolution in management of this disease from 2-stage to single-stage procedures. We report the case of a 45-year-old woman with an intravenous leiomyoma with intracardiac extension after presenting with syncopal symptoms. The intravenous tumor and its supradiaphragmatic extension were ultimately resected via laparotomy without the need for cardiopulmonary bypass. Distal control was achieved by passing an occluding balloon catheter above the tumor through a venotomy with fluoroscopic guidance and echocardiography, thus enabling protected tumor extraction through the intra-abdominal inferior vena cava. In selected patients, we believe use of endovascular techniques combined with proper preoperative imaging can safely permit single-stage resection of these tumors via laparotomy without cardiopulmonary bypass.
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Affiliation(s)
- Brian G Derubertis
- Division of Vascular Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York 10021, USA
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15
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Uchida H, Hattori Y, Nakada K, Iida T. Successful One-Stage Radical Removal of Intravenous Leiomyomatosis Extending to the Right Ventricle. Obstet Gynecol 2004; 103:1068-70. [PMID: 15121610 DOI: 10.1097/01.aog.0000127947.14387.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intravenous leiomyomatosis is a rare tumor originating from the uterus that spreads through vessels. This tumor, while histologically benign, can cause fatal cardiovascular symptoms resulting from growth within the heart cavity. CASE A 51-year-old woman with chronic hypertension was found to have a murmur. Echocardiogram, magnetic resonance imaging, and clinical evaluation revealed an intravenous leiomyomatosis extending to the right ventricle. The appropriate therapy for intravenous leiomyomatosis is complete resection. In this patient, one-stage cardiotomy with laparotomy resulted in successful radical removal of the tumor. CONCLUSION Our patient underwent successful radical therapy for an intravenous leiomyomatosis extending to the heart, which involved complete resection of the tumor by one-stage cardiotomy with laparotomy.
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Affiliation(s)
- Hiroshi Uchida
- Department of Obstetrics and Gynecology, Keio University, School of Medicine, Shinjuku, Tokyo, Japan.
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16
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Nam MS, Jeon MJ, Kim YT, Kim JW, Park KH, Hong YS. Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature. Gynecol Oncol 2003; 89:175-80. [PMID: 12694674 DOI: 10.1016/s0090-8258(02)00138-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravenous leiomyomatosis with intracaval and intracardiac extension has been rarely described in surgical, gynecological, and radiological literatures. Complete excision of the tumor is essential for a favorable outcome. Because of the uniqueness of this tumor having an absent or localized attachment site, its removal is feasible when assisted, prior to surgery, with appropriate imaging and planning. CASE The case was a 46-year-old woman, with intravenous leiomyomatosis originating from the uterus and extending to the inferior vena cava and right atrium, with extensive intracaval attachment, diagnosed from the various preoperative studies and operated successfully through the single-stage approach using cardiopulmonary bypass. CONCLUSION We present an unusual case of intravenous leiomyomatosis originating from the uterus and extending to the inferior vena cava and right atrium with extensive intracaval attachment. We include a brief review of the literatures.
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Affiliation(s)
- Mi Suk Nam
- Department of Obstetrics and Gynecology, BK21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
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18
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Roques F, Sanchez B, Bucher B, Larivière J. Role of pre-operative assessment in the surgical management of leiomyoma extended to the right heart chambers: a compendium of information from isolated reports. Eur J Cardiothorac Surg 2001; 19:522-4. [PMID: 11306327 DOI: 10.1016/s1010-7940(01)00604-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recurrent intravenous leiomyoma extending to the right heart chambers is extremely rare. A large range of surgical techniques and approaches (i.e. two-step procedure, hypothermia and circulatory arrest) have been previously described. We report a recent case where the tumour was excised in a one-step procedure under normothermic cardiopulmonary bypass. This report associated to a comprehensive literature review allows us to discuss the role of pre-operative assessment and to propose refinement of surgical techniques according to the anatomy of the tumour.
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Affiliation(s)
- F Roques
- Department of Cardiac Surgery, Fort de France University Hospital, 97200 Fort de France, Martinique.
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19
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Gehr NR, Lund O, Alstrup P, Nielsen JS, Villadsen AB, Bartholdy NJ. Recurrence of uterine intravenous leiomyomatosis with intracardiac extension. Diagnostic considerations and surgical removal. SCAND CARDIOVASC J 1999; 33:312-4. [PMID: 10540923 DOI: 10.1080/14017439950141597] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 28-year-old woman (gravida 2, para 2) was admitted 20 months after a hysterectomy because of fibromyoma. The hysterectomy specimen had shown intravenous leiomyomatosis. The patient presented with unspecific abdominal symptoms, serologic signs of hepatic and renal failure and clinical right-sided heart failure. Progression despite treatment with a gonadotropin-releasing hormone analogue promoted transferral to the present centre. Abdominal ultrasonography, phlebography and transoesophageal echocardiography showed a left pelvic mass and a seemingly free-floating tumour extending from the left main iliac vein via the inferior caval vein to the right ventricle. During a combined cardiac and distal caval approach using extracorporeal circulation, a 45 cm massive leiomyoma was removed successfully. Seven weeks later the left pelvic tumour was removed radically together with left oophorectomy. At control 12 months later the patient was well and without any remaining symptoms.
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Affiliation(s)
- N R Gehr
- Department of Cardio-Thoracic Surgery, Aalborg Hospital, Denmark
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20
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Abstract
A 59-year-old man presented with a 6-year history of a 2-cm tender nodule on his left lateral elbow. Excisional biopsy led to the diagnosis of angioleiomyoma. However, unlike typical angioleiomyoma which demonstrate extravascular extension, this lesion demonstrated purely intravascular growth.
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Affiliation(s)
- F P Sajben
- Department of Dermatology, Naval Medical Center San Diego, California 92134-1005, USA
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21
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Tsuji Y, Yamashita C, Wakiyama H, Toyoda Y, Yoshida M, Sugimoto T, Ataka K, Ishii N, Shida T, Okada M. Surgical treatment for transvenous tumor extension into the heart: four cases. J Vasc Surg 1998; 27:740-4. [PMID: 9576089 DOI: 10.1016/s0741-5214(98)70241-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
From 1984 to 1996, four patients with transvenous intracardiac tumor extension underwent operations in the Kobe University Hospital. The primary tumors of two were intravenous leiomyomatoses originating from the uterus; a third patient had invasive thymoma, and the fourth patient had clear cell sarcoma of the kidney. In 1985, one patient had a curative, staged resection. One-stage operations were carried out in three patients, and all intracardiac tumors were successfully resected en bloc with the primary tumors under conditions of electrical ventricular fibrillation and mild hypothermia. Combined venous reconstructions were necessary for en bloc resection in three cases. Two patients with malignancy received postoperative chemoradiotherapy, and all four patients were discharged uneventfully from our hospital. We consider radical resection with curative intent only for patients with tumors extending into the heart. In these cases, a one-stage operation is preferable, and electrical ventricular fibrillation with mild hypothermia is a recommended method of circulatory assist because of its simplicity.
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MESH Headings
- Adult
- Blood Vessel Prosthesis Implantation
- Brachiocephalic Veins/pathology
- Brachiocephalic Veins/surgery
- Cardiac Pacing, Artificial
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Extracorporeal Circulation
- Female
- Heart Arrest, Induced
- Heart Neoplasms/pathology
- Heart Neoplasms/surgery
- Humans
- Hypothermia, Induced
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Leiomyomatosis/pathology
- Leiomyomatosis/surgery
- Lung Neoplasms/secondary
- Male
- Middle Aged
- Neoplasm Invasiveness
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/surgery
- Neoplastic Cells, Circulating/pathology
- Patient Discharge
- Pericardium/transplantation
- Radiotherapy, Adjuvant
- Thymoma/pathology
- Thymoma/secondary
- Thymoma/surgery
- Thymus Neoplasms/pathology
- Thymus Neoplasms/surgery
- Time Factors
- Transplantation, Autologous
- Treatment Outcome
- Uterine Neoplasms/pathology
- Uterine Neoplasms/surgery
- Vascular Neoplasms/pathology
- Vascular Neoplasms/surgery
- Vascular Patency
- Vena Cava, Inferior/pathology
- Vena Cava, Inferior/surgery
- Vena Cava, Superior/pathology
- Vena Cava, Superior/surgery
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Affiliation(s)
- Y Tsuji
- Department of Surgery, Kobe University School of Medicine, Japan
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