1
|
Wang Q, Liu H, Feng W. Unraveling the challenges of intravenous leiomyomatosis: a retrospective analysis of 11 cases. Arch Gynecol Obstet 2024; 309:621-629. [PMID: 38085353 PMCID: PMC10808418 DOI: 10.1007/s00404-023-07308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study provides a concise overview of diagnostic and treatment strategies for intravenous leiomyomatosis (IVL), a rare disease with nonspecific clinical manifestations, based on cases from a tertiary referral hospital in China. METHODS We retrospectively analyzed 11 premenopausal patients with confirmed IVL between 2018 and 2022. Clinical data from Ultrasound, Enhanced CT, and MRI were studied, along with surgical details, postoperative pathology, and follow-up information. RESULTS Premenopausal patients showed no disease-specific symptoms, with 90.9% having a history of gynecological or obstetric surgery, and 72.7% having prior uterine fibroids. Cardiac involvement was evident in two cases, with echocardiography detecting abnormal floating masses from the inferior vena cava. Pelvic ultrasound indicated leiomyoma in 90.9% of cases, with ≥ 50 mm size. Surgery was the primary treatment, and lesions above the internal iliac vein resulted in significantly higher intraoperative blood loss (median 1300 ml vs. 50 ml, p = 0.005) and longer hospital stays (median 10 days vs. 4 days, p = 0.026). Three patients with lesions above the inferior vena cava required combined surgery with cardiac specialists. Recurrence occurred in 2 out of 11 patients with incomplete lesion resection. CONCLUSIONS IVL mainly affects premenopausal women with uterine masses, primarily in the pelvic cavity (Stage I). Pelvic ultrasound aids early screening, while Enhanced CT or MR assists in diagnosing and assessing venous lesions. Complete resection is crucial to prevent recurrence. Lesions invading the internal iliac vein and above pose higher risks during surgery. A multidisciplinary team approach is essential for patients with lesions above the inferior vena cava, with simultaneous surgery as a potential treatment option.
Collapse
Affiliation(s)
- Qun Wang
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hua Liu
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Weiwei Feng
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| |
Collapse
|
2
|
Wang J, Hu Q, Bi Z, Zhang J, Zhou L, Wu M, Liu H. MR imaging findings of stage I intravenous leiomyomatosis: a retrospective single-center study in 19 cases. Abdom Radiol (NY) 2024; 49:512-522. [PMID: 38168714 DOI: 10.1007/s00261-023-04132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES The aim was to explore the magnetic resonance imaging (MRI) features of stage-I intravenous leiomyomatosis (IVL). MATERIALS AND METHODS From January 2019 to January 2023, clinical, pathological, and MRI data were collected from 19 cases confirmed by surgical pathology. Two radiologists retrospectively measured the tumor sizes, T1WIs, T2WIs, and ADC values and evaluated contrast-enhanced T1WIs, DWIs, complications and parauterine infiltrations. The number of tumor cells and the total nuclear area were measured. The percentage of tumor cell area out of the total area was used as the tumor cell density. RESULTS Nineteen patients with stage-I IVL aged 33 to 66 years (mean age: 46 ± 7.6 years) were included in this study. All 19 cases were located in the myometrium or parametrium, with a mean diameter of 11.2 ± 4.8 cm. Among these cases, 14 (73.6%) were associated with leiomyoma, and six (31.6%) involved the broad ligament. Isointensity was observed in the T1WIs of 12 cases (63.2%), while slight hypointensity was seen in five patients (26.3%). Isointensity was observed in the on T2WIs of four cases (21.1%), and iso- or slight hyperintensity was observed in 15 cases (78.9%). A significant difference was detected between the normalized T2WIs of IVL and myometrium (p < 0.001). A Pearson correlation test showed demonstrated a negative correlation between the ADC and tumor cell density values (r = - 0.946, p < 0.001). Tortuous vessels were present in 17 cases (89.5%) within or next to the lesions, and multiple winding cord-like filling defects were seen in 11 cases (57.9%) within the tortuous vessels on the T2WIs. CONCLUSION Identifying the characteristic MRI features of stage-I IVL helped improve the diagnostic accuracy achieves for this rare tumor. Stage-I IVL often presents as a large mass accompanied by leiomyoma, and it easily invades the broad ligament. TIWI signals exhibited isointensity, and T2WI signals contained iso- or slight hyperintensity. Tortuous vessels were present within or next to the lesions, and multiple winding cord-like filling defects were observed within the tortuous vessels on the T2WIs.
Collapse
Affiliation(s)
- Jinhua Wang
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China.
| | - Qiwen Hu
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Zheng Bi
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jiamin Zhang
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Li Zhou
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Mengwei Wu
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Haiping Liu
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, Jiangxi, People's Republic of China
| |
Collapse
|
3
|
Li T, Yang K, Huang W, Chen F. Intravenous leiomyomatosis involved cor dextrum: A review of diagnosis and management with an illustrative case. Radiol Case Rep 2024; 19:503-508. [PMID: 38044903 PMCID: PMC10686894 DOI: 10.1016/j.radcr.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 12/05/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is a benign disease that originates in the uterus and is characterized by aggressive intravenous growth that can extend to the inferior vena cava and even involve the intracardiac cavity. This extension of the IVL into the right heart is known as intracardiac leiomyomatosis (ICL). The clinical incidence of this disease is extremely low, and the characteristics of atypical aggressive growth lead to diagnostic dilemmas. Thus, studies on this disease have profound clinical significance. Here, we report a case of intracardiac leiomyomatosis and review the relevant literature. A 46-year-old female patient presented with exertive chest tightness and shortness of breath with an onset of approximately half a month. The patient underwent uterine myomectomy in 2018 and recovered well after surgery. On preoperative echocardiography, a hypoechoic mass was detected in the right atrium, which was diagnosed as a leiomyoma. Cardiac magnetic resonance imaging (MRI) revealed a T2-weighted mixed high-signal mass with partial cystic changes that extended from the inferior vena cava into the right atrioventricular cavity, occupying most of the atrial cavity and was misdiagnosed as an atrial mucinous tumor. The patient underwent cardiac tumor resection, tricuspid valvuloplasty, and lower-extremity vascular exploration under general anesthesia with extracorporeal circulation. The final pathological diagnosis was ICL. This is an illustrative analysis of various aspects of the disease, including pathology, etiology, clinical symptoms, imaging diagnosis, and treatment modalities.
Collapse
Affiliation(s)
| | | | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dic, Haikou, Hainan, 570311, PR China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dic, Haikou, Hainan, 570311, PR China
| |
Collapse
|
4
|
Tan Y, Han J, Wang Z, Yan J, Dong L, Liu R. Different clinical diagnosis end up in the same pathological diagnosis of intravascular leiomyomatosis: Two case reports. Medicine (Baltimore) 2024; 103:e36887. [PMID: 38215104 PMCID: PMC10783399 DOI: 10.1097/md.0000000000036887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
RATIONALE Intravascular/intravenous leiomyomatosis (IVL) is a peculiar variant of uterine leiomyoma that is classified as a histologically benign smooth muscle tumor with a biological behavior similar to that of a malignant tumor. It is characterized by the proliferation of leiomyomas spreading along the uterine and extrauterine venous circulation. PATIENT CONCERNS Herein, we present 2 cases of IVL who had completely different clinical manifestations to stress the need for constant vigilance of IVL diagnosis and the understanding of uterine leiomyoma heterogenicity. Case 1 was registered for fever without specific triggering factors, irregular menstruation and clinically diagnosed uterine diverticula, while no information about fibroids was mentioned. Case 2 was characterized by an aggressively growing abdominal mass. With a large space-occupying lesion in the right abdominopelvic cavity and no imaging evidence of involvement of the iliac vein or above vein, the patient was initially diagnosed with multiple myomata. DIAGNOSES Both patients' diagnoses were confirmed as IVL by histopathology. To our knowledge, the mass of case 1 is the minimum IVL in the English literature. INTERVENTIONS Subtotal hysterectomy with bilateral salpingectomy was performed on the former, while total hysterectomy with bilateral salpingectomy was performed on the latter. OUTCOMES Both patients were comfortable, and no relapse occurred. LESSONS Two cases in the study showed 2 different proceeding stages of the same disease and corroborated multiple pathogeneses, which have been mentioned in the available literature on IVL. Our work provides both supplement for clinical data to facilitate further research and better understanding of special types of fibroids to clinicians.
Collapse
Affiliation(s)
- Yang Tan
- Department of Pathology, Dujiangyan Maternity and Child Health Hospital, Chengdu, Sichuan, China
| | - Jing Han
- Department of Pathology, Huayin Medical Laboratory Co., Ltd, Chengdu, Sichuan, China
| | - Zhenglan Wang
- Department of Pathology, Dujiangyan Maternity and Child Health Hospital, Chengdu, Sichuan, China
| | - Ju Yan
- Department of Pathology, Dujiangyan Maternity and Child Health Hospital, Chengdu, Sichuan, China
| | - Lin Dong
- Department of Pathology, Dujiangyan Maternity and Child Health Hospital, Chengdu, Sichuan, China
| | - Rui Liu
- Department of Pathology, Dujiangyan Maternity and Child Health Hospital, Chengdu, Sichuan, China
| |
Collapse
|
5
|
Gao Y, Qu P. Intravenous leiomyomatosis of the uterus: Preoperative and intraoperative assessment. Int J Gynaecol Obstet 2023; 163:825-833. [PMID: 37334980 DOI: 10.1002/ijgo.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/16/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To assess factors influencing preoperative diagnosis and hemorrhage during surgery with uterine intravenous leiomyomatosis. METHODS This retrospective single-institution study used univariate analysis and multivariate models to investigate potential factors contributing to preoperative diagnosis and hemorrhage during surgery associated with intravenous leiomyomatosis in 135 patients from January 2012 to April 2022. Risk factors for disease recurrence were also investigated. The SPSS statistical analysis package was used for data analysis. RESULTS Previous myomectomy or fibroid ablation and tumor location on color Doppler were related to preoperative diagnosis (P = 0.031 and P = 0.003, respectively). Multivariate regression analysis demonstrated that lesions extending to the broad ligament were the only factors affecting preoperative diagnosis (odds ratio [OR] 5.383, 95% confidence interval [CI] 1.49-19.47). Univariate analysis showed that previous myomectomy or fibroid ablation (P = 0.017), tumor location (P = 0.027), and parauterine involvement (P = 0.014) were associated with intraoperative hemorrhage. Parauterine involvement was an independent risk factor for increased bleeding (OR 1.36, 95% CI 1.14-3.92). Six patients (4.4%) relapsed. The present study demonstrated that age (P = 0.031) and surgical type (P < 0.001) might be associated with disease recurrence. CONCLUSIONS Treatment emphasis should focus on lesions extending to the broad ligament. Intraoperative bleeding associated with parauterine involvement should be stopped as effectively as possible.
Collapse
Affiliation(s)
- Yang Gao
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology Obstetrics Affiliated to Nankai University, Tianjin, China
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, China
| | - Pengpeng Qu
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology Obstetrics Affiliated to Nankai University, Tianjin, China
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, China
| |
Collapse
|
6
|
Ge Z, Wang Y, Wang Y, Li W, Yang X, Li J, Wang H. Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study. Front Oncol 2023; 13:1203591. [PMID: 37492474 PMCID: PMC10364609 DOI: 10.3389/fonc.2023.1203591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Intravenous leiomyomatosis (IVL) is a rare and aggressive tumor type that has the potential to extend into the inferior vena cava (IVC) and is susceptible to be misdiagnosed and neglected. Despite its clinical significance, there is a paucity of research that has focused on the specific manifestations of IVL on ultrasonography. Therefore, this study aims to systematically analyze the specific ultrasound features of IVL and augment its diagnostic accuracy. Materials and method Prospective inclusion was granted to patients admitted to our hospital between December 2016 and March 2021 for an IVC-occupying lesion. Multi-modal ultrasonography, encompassing gray-scale and color Doppler, was conducted. Lesions were categorized as IVL or non-IVL based on pathological or follow-up data. Two ultrasound sonographers with over 5 years of experience read and recorded ultrasound data for all lesions, which were subsequently comparatively analyzed to identify specific signs of IVL. Results A total of 284 patients diagnosed with IVC-occupying lesions were included in the study. The lesion types comprised of IVL (n=67, 23.6%), IVC thrombus (n=135, 47.5%), tumor thrombus of renal carcinoma involving the IVC (n=35, 12.4%), tumor thrombus of liver carcinoma involving the IVC (n=24, 8.5%), leiomyosarcoma of the IVC (n=14, 4.9%), and tumor thrombus of adrenocortical adenocarcinoma (n=9, 4.1%). The presence of "sieve hole" and "multi-track" signs was observed in 20 IVL lesions under the grey-scale modality, while both signs were absent in the non-IVL group (P<0.01). The study found no statistically significant differences in the presentation of "sieve hole" and "multi-track" signs under the grey-scale and color Doppler modalities in cases of intravascular lithotripsy (IVL) (P>0.05). Using these two signs as diagnostic criteria for IVL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), miss rate, misdiagnosis rate, and accuracy were determined to be 29.9%, 100%, 100%, 82.2%, 70.1%, 0, and 83.5%, respectively (AUC ROC=0.649; 95%CI: 0.537-0.761). Conclusion IVL exhibits distinct ultrasound presentations, including "sieve hole" and "multi-track" signs, which demonstrate high specificity and accuracy as diagnostic indicators. Furthermore, these signs are corroborated by pathological evidence and effectively distinguish IVL from other lesions occupying the IVC.
Collapse
Affiliation(s)
| | | | | | | | | | - Jianchu Li
- *Correspondence: Jianchu Li, ; Hongyan Wang,
| | | |
Collapse
|
7
|
Zhuang Y, Yang DC, Xi XW, Ye YZ. Two Case Reports of Intravenous-Cardiac Leiomyomatosis. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
|
8
|
Zhanga Y, Wua X. Treatment of intravascular leiomyomatosis: cases report and literature review. J Vasc Surg Cases Innov Tech 2023; 9:101059. [PMID: 37152917 PMCID: PMC10160508 DOI: 10.1016/j.jvscit.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/25/2022] [Indexed: 02/17/2023] Open
Abstract
Intravascular leiomyomatosis is a rare disease characterized by the proliferation of a smooth muscle tumor in the vascular lumen and possible cardiac extension. The best surgical procedure is yet to be identified. The present study aimed to explore the optimal surgical strategies. Fourpatients with intravascular leiomyomatosis in our hospital were analyzed retrospectively. All patients underwent one-stage surgery with multidisciplinary collaboration and were followed for 2 to 56 months. Based on the preliminary results, we found that one-stage surgery is safe and effective. We recommended Ma's staging system as a guide for selecting the surgical procedures.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Barreto-Coelho P, Rosenberg A, Subhawong T, Costa P, Espejo-Freire AP, Bialick S, Jonczak E, Trent JC, D'Amato GZ. Treatment of Disseminated Intravenous Leiomyomatosis With ALK Targeting Crizotinib: A Successful Case Report. JCO Precis Oncol 2022; 6:e2100336. [PMID: 35108034 DOI: 10.1200/po.21.00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Priscila Barreto-Coelho
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Andrew Rosenberg
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Ty Subhawong
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Philippos Costa
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Andrea P Espejo-Freire
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Steven Bialick
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Emily Jonczak
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Jonathan C Trent
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| | - Gina Z D'Amato
- Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, University of Miami Health System, Miami, FL
| |
Collapse
|
11
|
Liang J, Lei R, Xie M, Lin S, Xu J, Ling X, Xie Q. The role of estrogen deprivation therapy in premenopausal women with primary unresectable intracardiac leiomyomatosis: a systematic review and meta-analysis. Orphanet J Rare Dis 2021; 16:453. [PMID: 34715881 PMCID: PMC8555203 DOI: 10.1186/s13023-021-02087-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intracardiac leiomyomatosis (ICLM) is a rare life-threatening form of intravenous leiomyomatosis (IVLM). The incomplete resection and recurrence are associated with high morbidity and mortality. The objective of this study is to identify that whether estrogen deprivation therapies, including bilateral salpingo-oophorectomy (BSO)-based surgery and gonadotrophin releasing hormone agonists (GnRHa) administration, could bring benefits to patients with primary unresectable ICLM. METHODS PubMed/MEDLINE (Ovid) was searched (up to May 2021) for studies reporting individual patient data on demographics, clinicopathological features, treatment, and follow-up information. Exclusion criteria were patients who may have been included in two or more publications. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 114 patients from 70 papers were included. Several reports showed that the tumor in the right atrium and inferior vena cava shrank dramatically after BSO-based surgery, or GnRHa administrated preoperatively in premenopausal women. The rate of complete resection was 64.04% in patients with ICLM, which was 85.25% in no/slight adhesion and no pulmonary nodules group, while 22.22% in firm/extensive adhesion and/or pulmonary nodules group (p < 0.0001). Meanwhile, the recurrence rates in patients with complete resection and incomplete resection were 4.29% and 37.84% respectively (p < 0.0001). Furthermore, complete resection with BSO had the lowest recurrence rate of 3.13%, incomplete resection with BSO had a progression rate of 45.45%, while incomplete resection with ovarian preservation had the highest progression rate of 75.00%. CONCLUSIONS The recurrence rate of ICLM was closely related to firm/extensive adhesion in IVC or above, and/or pulmonary nodules. BSO-based surgery might reduce the recurrence rate no matter ICLM could be completely resected or not. In addition, estrogen deprivation therapies could decrease tumor burden as a primary treatment, and further make a secondary complete resection feasible in premenopausal women with initially unresectable ICLM.
Collapse
Affiliation(s)
- Jinxiao Liang
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Ruilin Lei
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Mingwei Xie
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Shaodan Lin
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Jing Xu
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Xiaoting Ling
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China.
| | - Qingsheng Xie
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China.
| |
Collapse
|
12
|
Peng J, Zhong F, Zhu Y, Zhang M, Zhang M, Lu C, Wang Y, Qi X, Wang C, Li G. Clinical analysis of uterine intravenous leiomyomatosis: A retrospective study of 260 cases. J Obstet Gynaecol Res 2021; 47:4357-4364. [PMID: 34525488 PMCID: PMC9293182 DOI: 10.1111/jog.15013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/31/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
Methods We collected the clinical data of 260 patients admitted to the hospital from April 2003 to September 2019 with pathologically confirmed intravenous leiomyomatosis (IVL) and followed up with these patients regularly. Univariate and multivariate logistic regression analyses were carried out on the relevant recurrence factors. Results A total of 166 patients were regularly followed up, the median follow‐up time was 36 (range 2–168) months, 14 (5.4%) patients eventually relapsed, and the median recurrence time was 8.5 (range 2–42) months. The univariate analysis showed that age (p = 0.003) and surgical type (p < 0.001) were associated with recurrence, and multivariate regression analysis demonstrated that surgical type was the only factor associated with recurrence (p < 0.001, OR 20.01). Conclusions The use of gonadotrophin releasing hormone agonist (GnRHa) cannot reduce the postsurgical recurrence rate of patients with UIVL. Compared to total hysterectomy and bilateral salpingo‐oophorectomy (TH‐BSO), total hysterectomy (TH) does not increase the odds of recurrence, but the chance of recurrence with tumorectomy (TE) is 20 times higher than that of TH‐BSO.
Collapse
Affiliation(s)
- Jing Peng
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Fangfang Zhong
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yuemeng Zhu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Mingxing Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Meng Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Chong Lu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yumeng Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Xingling Qi
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Congwen Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Guiling Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| |
Collapse
|
13
|
Lu ZY, Zhang N, Zhang Y. Myomectomy for intravenous leiomyomatosis: a retrospective series of 9 cases. J OBSTET GYNAECOL 2021; 42:665-669. [PMID: 34396916 DOI: 10.1080/01443615.2021.1929110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study aimed to evaluate the clinical outcomes of patients with intravenous leiomyomatosis (IVL) who underwent myomectomy. Clinical data were retrieved from our database from January 2001 to October 2018. Of 197 patients with IVL, 9 (4.6%) patients were included. The patients' age ranged from 24 to 46 (mean: 31.1 ± 7.3) years. Five (55.6%) patients had not yet given birth upon IVL diagnosis. Three patients were treated with gonadotropin-releasing hormone agonists after surgery. The average follow-up time was 58.9 ± 27.8 (range: 29-122) months. Four patients presented with new uterine masses during follow-up. Three patients had natural pregnancies and live births. This information may provide a glimmer of hope to young patients with uterus-confined IVL who have fertility desires. However, future multicenter studies with larger sample sizes and longer follow-up periods are warranted.Impact statementWhat is already known on this subject? The best treatment options for intravenous leiomyomatosis (IVL) are hysterectomy with bilateral salpingo-oophorectomy and complete resection of intravenous extensions of the disease.What the results of this study add? Nine patients with IVL underwent myomectomy. After a mean follow-up period of 58.9 ± 27.8 months, 3 patients had natural pregnancies and live births.What are the implications of these findings for clinical practice and/or further research? The result might provide a glimmer of hope to young patients with uterus-confined IVL who have fertility desires.
Collapse
Affiliation(s)
- Zhi-Ying Lu
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ning Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ying Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| |
Collapse
|
14
|
Mathey MP, Duc C, Huber D. Intravenous leiomyomatosis: Case series and review of the literature. Int J Surg Case Rep 2021; 85:106257. [PMID: 34343794 PMCID: PMC8350006 DOI: 10.1016/j.ijscr.2021.106257] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/17/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Intravenous leiomyomatosis (ILV) is a rare pathology, part of leiomyoma beyond the uterus (LBU), characterized by benign smooth muscle cell tumor outside of the uterus and mainly affecting premenopausal woman with a medical history of leiomyoma or gynecologic surgical treatment. The treatment depends on the localization of the tumor, age of the patient, initial size, symptoms and the suitability for surgery but should always aims in toto surgical resection. Case presentation Retrospective case series and review of literature. Clinical discussion Symptoms presented by the patient were aspecific and only localized in the pelvic area. All cases were fortuitous histopathological diagnosis. No relapse was. Two out of 5 patients have pulmonary nodules, only one was biopsied and diagnosed with PBML (pulmonary benign metastasizing leiomyoma). Conclusion IVL and BML are rare disease that can co-exist. Because of tumoral hormonal receptors, hormonotherapy could be an optional treatment but to date no clear efficacy is demonstrated. In case of high recurrence risk such as voluminous initial mass, impairment of broad ligament, failure of total surgical resection, adjuvant hormonotherapy could be useful. Recurrence rate is about 16.6-30% and can occur even dozen years later and even after radical surgery, justifying a regular follow up. Leiomyomas beyond the uterus (LBU) is defined by benign smooth muscle cell tumor outside of the uterus. Sub classification of this entity are intravenous leiomyomatosis (IVL), benign metastasizing leiomyomas (BML), diffuse peritoneal leiomyomatosis (DPL), retroperitoneal leiomyomas and parasitic leiomyomas. The differential diagnosis of IVL should include benign myoma, thrombus, leiomyosarcoma, soft tissue sarcoma, lymphoma, cardiac myxoma, tumor thrombosis of Wilms tumor or metastasis. Treatment of IVL is usually surgery but there is no consensus about the the optimal approach. Adjuvant therapy sur as bilateral salpingoophorectomy followed by hormonothetherapy have to be balanced with their side effects. Despite being histologically benign, BML shows the metastatic potential of LBU. Because of a high rate of recurrence estimated of 16.6% to 30%, long term follow up is recommended even after radical surgery.
Collapse
Affiliation(s)
- M P Mathey
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - C Duc
- Department of Pathology, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland
| | - D Huber
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland; Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| |
Collapse
|
15
|
Xu X, Ma G, Miao Q, Liu X, Zhang C, Liu J, Shao J, Cheng N, Cao D. Non-open-heart surgery for intravascular leiomyomatosis extending from the inferior vena cava to the right heart chamber. J Vasc Surg Venous Lymphat Disord 2021; 10:409-416. [PMID: 34252578 DOI: 10.1016/j.jvsv.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the present study, we analyzed the advantages and feasibility of non-open-heart surgery without cardiopulmonary bypass for intracardiac intravenous leiomyomatosis. METHODS We retrospectively reviewed 23 cases of intracardiac intravenous leiomyomatosis and divided them into a noncardiopulmonary bypass (NCPB) group (9 cases) and a cardiopulmonary bypass (CPB) group (14 cases) according to the surgical treatment received. The clinical characteristics and anatomic features, including the diameter of the tumor, right atrium, and inferior vena cava, were recorded, and the perioperative data, including the operation time, blood loss, postoperative hemoglobin change, and follow-up results, were analyzed and compared between the two groups. RESULTS The NCPB group had required a shorter operation time (321.9 ± 104.2 minutes vs 526.3 ± 95.6 minutes; P < .001) and had experienced less blood loss (456.3 ± 249.9 mL vs 815.4 ± 435.6 mL; P = .048) compared with the CPB group. The NCPB group had a small maximum cross-sectional area of the tumor inside the right atrium (475.5 ± 509.6 mm2), a low proportion of the maximum cross-sectional area of the entrance of the right atrium (average, 26.1%), no tricuspid valve or atrial wall involvement, and high mobility inside the inferior vena cava and heart chamber. All 23 patients had recovered well postoperatively, and no recurrence had developed during 24 months of follow-up. CONCLUSIONS For intravenous leiomyomatosis with a smaller cross-sectional area in the right atrium that can be mobilized, surgery without CBP is feasible and should be considered.
Collapse
Affiliation(s)
- Xiaolin Xu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingrong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ninghai Cheng
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
16
|
Schultz KL, Quinn SM, Miller AH, Fieman RE, Cipolle MD, Misselbeck TS, Roth KR. Point of care ultrasound facilitated diagnosis of right ventricular mass as the etiology of syncope; A case report of intravenous leiomyomatosis. Radiol Case Rep 2021; 16:1288-1293. [PMID: 33854666 PMCID: PMC8026911 DOI: 10.1016/j.radcr.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Syncope is a common emergency department (ED) chief complaint. Rarely, syncope can be the result of right ventricular outflow obstruction from an intracardiac tumor, such as an intracardiac extension of intravenous leiomyomatosis (IVL). Typically, this type of tumor is confined to the pelvic veins, but in very rare cases, it can extend through the inferior vena cava into the right atrium. Point-of-care ultrasound (POCUS) can be a crucial tool in the ED for identifying intracardiac tumors presenting as syncope and expediting clinical management. We present the case of a 39-year-old female with no prior medical history that presented to the ED having experienced dyspnea on exertion and two syncopal episodes prior to ED admission. POCUS use in the ED elucidated the presence of a right atrial mass and further imaging showed a mass on the patient's uterus. After surgical removal of a portion of the atrial mass, a subsequent biopsy revealed it had leiomyoma-like features; as such, the patient was diagnosed with IVL. This case illustrates the importance of using POCUS in the ED to help determine the etiology of syncope. Although intracardiac extensions of IVL are rare, it is important for emergency physicians to keep this diagnosis in the differential in patients with symptoms or risk factors suggestive of IVL with intracardiac extension.
Collapse
Affiliation(s)
- Kristine L Schultz
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Shawn M Quinn
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Andrew H Miller
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Rachel E Fieman
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Mark D Cipolle
- Department of Surgery, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Timothy S Misselbeck
- Department of Surgery, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Kevin R Roth
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| |
Collapse
|
17
|
Han Y, Chung YJ, Shin I, Park JY, Shim S, Hijazi A, Song JY, Cho HH, Kim MR. Intravenous leiomyomatosis misdiagnosed with large thrombosis in inferior vena cava. Taiwan J Obstet Gynecol 2021; 60:367-369. [PMID: 33678345 DOI: 10.1016/j.tjog.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this report is to highlight the importance of a comprehensive preoperative evaluation in the case of intravenous leiomyomatosis. CASE REPORT A 49-year-old women was presented with dyspnea and abdominal distension. Imaging studies revealed a large leiomyoma with intravenous leiomyomatosis from this mass to the right parauterine veins, right ovarian vein reaching the inferior vena cava. Complete resection was performed by a two-stage operation by a multidisciplinary team. Final pathology confirmed it to be intravenous leiomyomatosis and uterine leiomyomas. CONCLUSION Intravenous leiomyomatosis is a benign and rare disease that can be a fatal condition. Precise diagnosis and appropriate treatment are important for the best outcome. Gynecologists should consider this rare disease when a patient with a uterine tumor shows symptoms such as chest pain and dyspnea.
Collapse
Affiliation(s)
- Youngsin Han
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youn-Jee Chung
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Inhye Shin
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Yoon Park
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suhyun Shim
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ayah Hijazi
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Yen Song
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Hee Cho
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Collage of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
18
|
Deng Y, Dong S, Song B. Surgical Strategy for Intravenous Cardiac Leiomyomatosis. Heart Lung Circ 2020; 30:240-246. [PMID: 32830033 DOI: 10.1016/j.hlc.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Intravenous-cardiac leiomyomatosis (IVCL) is a rare, histologically benign but biologically aggressive tumour. Accurate diagnosis and appropriate treatment choices are important for prognosis. The best surgical approach remains unclear owing to limited evidence. This study aimed to assess surgical strategies for treating IVCL and to propose individualised surgical strategies. We searched PubMed, Web of Science, and the Cochrane Library to identify case reports and case series published in English over the last 10 years. Two (2) reviewers independently screened the literature according to the inclusion and exclusion criteria, and subsequently extracted data. One hundred and ten (110) cases were included. According to our analysis, IV cardiac leiomyomatosis is most common in the fifth decade, and the mean age at detection is 45.71±7.67 years. Most patients had undergone previous hysterectomy/myomectomy, or had a co-existing uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, palpitation, pelvic mass, and leg oedema. More patients benefited more from one-stage surgery. Seventy-eight per cent (78%) of cases experienced a surgical approach of thoracic and abdominal incisions. Extractions of IVCL were varied. Eighty-seven (87) patients experienced cardiopulmonary bypass and deep hypothermic circulatory arrest was performed on 64.4% of them. Total hysterectomy and bilateral oophorectomy, together with pelvic leiomyoma excision, were done in 76.0% of patients. Overall, surgical strategies for IVCL are varied; the optimal strategy required consideration of multiple factors. Complete resection is recommended for both single- and two-stage operations. Once complete resection is achieved, recurrence is rare.
Collapse
Affiliation(s)
- Yundan Deng
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Shuai Dong
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Bing Song
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China.
| |
Collapse
|
19
|
Intravascular Leiomyomatosis as a Rare Cause of Nonthrombotic Pulmonary Embolism. Case Rep Vasc Med 2020; 2020:6084061. [PMID: 32733736 PMCID: PMC7378625 DOI: 10.1155/2020/6084061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022] Open
Abstract
Intravascular leiomyomatosis (IVL) is a very rare condition. It is characterized by the proliferation of benign smooth muscle cells within vascular structures without invasion of these tissues. Symptoms depend on the site of origin and the extent of invasion. Rarely, this neoplasm is located in the inferior vena cava or in the pulmonary vasculature potentially causing symptoms of dyspnea, chest pain, or syncope. We report the case of a 53-year-old woman who was referred to our hospital with extensive pulmonary embolism comprising of a subtotal occlusion of the right pulmonary artery with extension into the left pulmonary artery. Due to persistent dyspnea (New York Heart Association class II) despite anticoagulation, after a six-week period, imaging was repeated and showed stable findings. As she was not responding to adequate anticoagulant therapy, intima sarcoma of the pulmonary artery was suspected, and a pulmonary endarterectomy (PEA) was performed. A smooth, white, intravascular mass was easily and completely removed. Analysis demonstrated a lesion consisting of cells without atypia, showing expression of alpha-smooth muscle actin (alpha SMA) and desmin with partial expression of estrogen receptor (ER) and progesterone receptor (PR), leading to the diagnosis of intravascular leiomyomatosis. The patient fully recovered. Complete surgical removal of the intravascular tumor is recommended to relieve symptoms and prevent possible complications. Clinicians have to be aware that in unresolved pulmonary embolism, nonthrombotic and rare causes, like an intima sarcoma or intravascular leiomyomatosis, should be considered.
Collapse
|
20
|
Lian C, Yin S, Qiu J, Cui J, Hu Z, Chang G, Wang S, Wang J. Experience in the diagnosis and treatment of intravenous leiomyomatosis involving the inferior vena cava and/or right cardiac chambers. J Vasc Surg Venous Lymphat Disord 2020; 9:452-460. [PMID: 32464287 DOI: 10.1016/j.jvsv.2020.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to summarize our experience with the diagnosis and treatment of intravenous leiomyomatosis (IVL) involving the inferior vena cava (IVC) or right cardiac chambers. METHODS This study retrospectively analyzed clinical data from 10 patients diagnosed with IVL involving the IVC or right cardiac chambers between May 2009 and October 2019 at one medical center. RESULTS All patients were females aged 35 to 56 years (average, 46.8 years) with a history of uterine leiomyoma. Of these 10 patients, 8 manifested clinical symptoms and 2 were asymptomatic. Four were diagnosed with lesions involving the right cardiac chambers, four had lesions that extended into the suprahepatic IVC, and an additional two had lesions extending into the infrarenal IVC. All patients underwent surgery. Three of the four patients with extension into the right cardiac chambers underwent a two-stage operation, and an additional patient was managed with a one-stage operation. Patients who underwent a two-stage operation experienced less hemorrhaging and a shorter intensive care unit stay than the patient who underwent a one-stage operation. Six patients with intracaval extension alone underwent laparotomy, including four with a lesion extending into the suprahepatic IVC, under transesophageal echocardiography monitoring. Bilateral adnexectomy and ovariectomy were performed in seven patients, and unilateral adnexectomy and ovariectomy were performed in two patients; antiestrogen therapy was administered to two patients who retained a unilateral ovary and to one patient who retained bilateral ovaries. One patient suffered deep vein thrombosis in the left lower extremity after surgery that improved after treatment. All patients received conventional anticoagulant treatment postoperatively. All pathologic findings confirmed IVL, and the follow-up period ranged from 27 to 120 months (average, 57.5 months). Recurrence was not observed in the iliac vein or IVC, excluding one case of pelvic leiomyoma that recurred at one year postoperatively. CONCLUSIONS IVL should be highly suspected when an IVC mass occurs in a patient with a history of uterine leiomyoma. Surgery is the gold standard treatment for IVL; a two-stage operation is more beneficial for patient recovery if the lesion exhibits intracardiac involvement, and transesophageal echocardiography is a helpful tool to monitor safety during surgical procedure for patients with a lesion invading the IVC above the level of the renal vein.
Collapse
Affiliation(s)
- Chong Lian
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Shengli Yin
- Division of Cardio-Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Jiacong Qiu
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Jin Cui
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Zuojun Hu
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Guangqi Chang
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Shenming Wang
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Jinsong Wang
- Division of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China.
| |
Collapse
|
21
|
Intravenous Leiomyomatosis of the Uterus: A Retrospective Single-Center Study in 14 Cases. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9758302. [PMID: 32337287 PMCID: PMC7155762 DOI: 10.1155/2020/9758302] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 12/02/2022]
Abstract
Purpose This study aimed to retrospectively review the diagnosis and surgical treatment of uterine intravenous leiomyomatosis (IVL). Methods The clinical data of 14 patients with uterine IVL admitted to our hospital between 2013 and 2018 were retrospectively analyzed, including their demographics, imaging results, surgical procedures, perioperative complications, and follow-up results. Results The tumors were confined to the pelvic cavity in 7 patients, 1 into the inferior vena cava, 4 into the right atrium, and 2 into the pulmonary artery (including 1 into the superior vena cava). Only one case was misdiagnosed as right atrial myxoma before the operation, which was found during the surgery and was treated by staging surgery; all the other patients underwent one-stage surgical resection. Three patients underwent complete resection of the right atrial tumor through the abdominal incision, and one patient died of heart failure in the process of resection of heart tumor without abdominal surgery. During the 6–60 months of follow-up, 4 patients developed deep venous thrombosis of the lower extremity, and 1 patient developed ovarian vein thrombosis and pulmonary embolism. After anticoagulation treatment, the symptoms disappeared. One patient refused hysterectomy and the uterine fibroids recurred 4 years after the operation. Conclusion Specific surgical plans for uterine IVL can be formulated according to cardiac ultrasound and computed tomography (CT). For the first type of tumor involving the right atrium, the right atrium tumor can be completely removed through the abdominal incision alone to avoid thoracotomy. The disease is at high risk of thrombosis and perioperative routine anticoagulation is required.
Collapse
|
22
|
Zaidi AZ, Hawley I, Zaidi J. Intravenous leiomyomatosis-a case report. J OBSTET GYNAECOL 2020; 41:996-997. [PMID: 32293219 DOI: 10.1080/01443615.2020.1738362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Z Zaidi
- St George's University of London, London, UK
| | - I Hawley
- Conquest Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - J Zaidi
- Conquest Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
| |
Collapse
|
23
|
Andrade D, Vinck EE, Torres LN, Citarella D. Surgical removal of intravascular leiomyomas with intracardiac extension: A two-case report. J Card Surg 2020; 35:1094-1097. [PMID: 32227364 DOI: 10.1111/jocs.14525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 11/29/2022]
Abstract
Leiomyomatosis is a uterine condition that can rarely present with extrauterine involvement. Intravenous and intracardiac extensions are extremely rare presentations and, in these cases, the intra-cardiac mass may be confused with a cardiac myxoma and can be associated with pulmonary embolism. Here we report two cases of successful surgically removed intracardiac leiomyomas under cardiopulmonary bypass.
Collapse
Affiliation(s)
- Darío Andrade
- Department of Cardiac Surgery, Fundación Clínica Shaio, Bogota, Colombia
| | - Eric E Vinck
- Department of Cardiac Surgery, Fundación Clínica Shaio, Bogota, Colombia
| | | | - Danilo Citarella
- Department of Oncological Urology, Fundación Clínica Shaio, Bogota, Colombia
| |
Collapse
|
24
|
Chin CH, Chen TH. A tumor mass from inferior vena cava extending to right atrium. Kaohsiung J Med Sci 2019; 36:71-72. [PMID: 31571394 DOI: 10.1002/kjm2.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chih-Hui Chin
- Cardiovascular Center, Cathay General Hospital, Taipei, Taiwan
| | | |
Collapse
|
25
|
Abstract
RATIONALE Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign. PATIENT CONCERNS A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy. DIAGNOSES Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made. INTERVENTIONS The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully. OUTCOMES Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence. LESSONS The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.
Collapse
|
26
|
Marrone G, Crinò F, Morsolini M, Caruso S, Miraglia R. Multidisciplinary approach in the management of uterine intravenous leiomyomatosis with intracardiac extension: case report and review of literature. J Radiol Case Rep 2019; 13:1-13. [PMID: 31558962 DOI: 10.3941/jrcr.v13i7.3607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Uterine intravenous leiomyomatosis is an uncommon tumor, usually arising from the uterus, with nodular masses which extend intravascularly over variable distances and may reach the inferior vena cava, right atrium, and pulmonary arteries. Early diagnosis and surgical intervention are crucial as intracardiac leiomyomatosis not only causes cardiac symptoms but may result in pulmonary embolism and sudden death. Complete tumor resection is key in disease management, thus rendering cardiac-extending uterine intravenous leiomyomatosis one of the most challenging conditions for surgical treatment. The use of interventional radiology procedures can facilitate the surgical approach. We report the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and pulmonary embolism, analyzing management and surgical outcomes, highlighting the role of interventional radiology during the therapeutic pathway. Nonetheless, there are currently very few data available concerning the use of interventional radiology procedures in the therapeutic strategy of uterine intravenous leiomyomatosis with intracardiac extension.
Collapse
Affiliation(s)
- Gianluca Marrone
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Francesca Crinò
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Marco Morsolini
- Department of Cardio-Thoracic Surgery, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Settimo Caruso
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Roberto Miraglia
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| |
Collapse
|
27
|
Luo G, Pan H, Bi J, Luo Y, Zhu J, Feng Z, Fan H, Zhang Y, Dai X. Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series. J Int Med Res 2019; 47:3465-3474. [PMID: 31280644 PMCID: PMC6683876 DOI: 10.1177/0300060519858021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.
Collapse
Affiliation(s)
- Guangze Luo
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China.,2 Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongrui Pan
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China.,2 Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiaxue Bi
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yudong Luo
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiechang Zhu
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhou Feng
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hailun Fan
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yiwei Zhang
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangchen Dai
- 1 Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin, China.,2 Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
28
|
Liu J, Liang M, Ma G, Liu X, Cheng N, Cao D, Yu C, Du S, Miao Q, Zhang C. Surgical treatment for intravenous-cardiac leiomyomatosis. Eur J Cardiothorac Surg 2019. [PMID: 29514177 DOI: 10.1093/ejcts/ezy084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES There are few published studies on the rare disorder of intravenous-cardiac leiomyomatosis (IVCL). This study aimed to propose an individualized strategy for surgical treatment of IVCL. METHODS In this retrospective study, we reviewed 50 patients who had undergone IVCL removal from November 2002 to October 2017 in our hospital. IVCL was classified as Type A-E according to the extent and size, with Type E being the most severe. Clinical manifestations, surgical features and follow-up data were analysed. RESULTS Of the 50 patients in this series, 8 had Type A IVCL, 8 Type B, 29 Type C, 2 Type D and 3 Type E IVCL. One-stage removal of IVCL was performed via laparotomy without cardiopulmonary bypass (CPB) in the 8 patients with Type A, 1-stage tumour resection via sternolaparotomy under deep hypothermic arrest in 7 of the 8 patients with Type B and IVCL removal via sternolaparotomy under CPB, with 27 also under deep hypothermic arrest, in all 29 patients with Type C. Sixteen of the patients with Type C IVCL underwent staged procedures, 13 a 1-stage procedure and 21 required hepatic mobilization. All patients with Type C or E cases underwent 1-stage tumour removal via sternolaparotomy under deep hypothermic arrest. All 50 patients survived surgery. IVCL was confirmed postoperatively by histology. Ten patients had residual tumours; 9 of which did not progress. No deaths occurred during 47.8 ± 38.4 (range 1-177) months of follow-up. CONCLUSIONS The only known curative treatment for IVCL is surgery. Herein, we present an individualized strategy for selecting surgical treatment.
Collapse
Affiliation(s)
- Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Liang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingrong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ninghai Cheng
- Department of Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- Department of Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shunda Du
- Department of Hepatic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
29
|
Ghanem M, Meyer F, Jechorek D, Schoeder V, Ignatov A, Fadel M, Halloul Z. Intravascular (post-hysterectomy) leiomyoma (IVL) as late tumor thrombus within the inferior vena cava (IVC)-A rare case primarily imposing as IVC thrombus originating from left renal vein after former left nephrectomy status. Pathol Res Pract 2019; 215:152359. [PMID: 30853174 DOI: 10.1016/j.prp.2019.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/28/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Intravascular leiomyoma is a rare type of myoma. It was firstly described by Birch-Hirschfeld in 1896, however, its intracardiac subtype was firstly reported by Durck in 1907. Most patients are asymptomatic. The tumor invades mostly the tributaries of the inferior vena cava (IVC) with upward extension that may approach the intracardiac space. AIM By means of a scientific case report, a patient with the very rare diagnosis of an endocaval leiomyoma thrombus post-hysterectomy is described based on the clinical experiences obtained in the specific case management and selective references from the literature. CASE PRESENTATION A 48-years old female was diagnosed with intravascular tumor growth within the IVC with intracardiac extension using chest and abdominal CT scan, ECG and echocardiography which was approached by an interdisciplinary (vascular and cardiothoracic) surgical intervention (278 min) including heart-lung machine (99 min) with favorable postoperative result (R0 resection status with mid-term outcome, no recurrent tumor growth). Histopathological investigation diagnosed leiomyoma origin already from ovarian vein most likely in context to the former hysterectomy (3 years ago). DISCUSSION AND CONCLUSION Intravascular leiomyoma is a benign tumor with invasive tendency, which can be considered a diagnostic and therapeutic challenge. It should be thoroughly investigated to be planned for a radical surgical removal. By possible adherence to the intraabdominal or -thoracic organs, an interdisciplinary and eventually step-wise surgical approach (combining vascular, abdominal, thoracic and heart surgery as well as gynecology and urology), which can be demanding, is recommended to be seriously considered to i) reliably achieve R0 resection status and, thus, ii) provide best outcome, quality of life and prognosis.
Collapse
Affiliation(s)
- M Ghanem
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - F Meyer
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - D Jechorek
- Institute of Pathology, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - V Schoeder
- Institute of Pathology, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - A Ignatov
- Dept. of Gynecology and Obstetrics, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - M Fadel
- Dept. of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany
| | - Z Halloul
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Otto-von-Guericke University at Magdeburg, Germany.
| |
Collapse
|
30
|
Zhang X, Wu L, Xu R, Zhu C, Ma G, Zhang C, Liu X, Zhao H, Miao Q. Identification of the molecular relationship between intravenous leiomyomatosis and uterine myoma using RNA sequencing. Sci Rep 2019; 9:1442. [PMID: 30723247 PMCID: PMC6363745 DOI: 10.1038/s41598-018-37452-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to explore the potential relationship between intravenous leiomyomatosis (IVL) and uterine myoma (UM) at the molecular level. RNA-sequencing was performed on IVL tumours, UM tumours, and adjacent normal uterine muscle. We compared the gene expression levels between IVL and normal uterine muscle, UM and normal uterine muscle, to identify differentially expressed genes (DEGs). Then we used Gene Ontology Enrichment Analysis to determine the functions of the DEGs and performed specimen cluster analysis. We obtained 98 DEGs between IVL and adjacent normal uterine muscle, and 61 DEGs between UM and adjacent normal uterine muscle. Functional enrichment of both IVL and UM DEGs showed that they are associated with hormone stimulus, extracellular matrix, and cell adhesion. Unsupervised clustering analysis showed that IVL and UM could not be separated completely. Among these dysregulated genes, we found that HOXA13 showed a distinct dysregulated status between IVL and UM. HOXA13 may therefore serves as a biomarker to distinguish IVL and UM. Our results showed that IVL and UM may have similar dysregulated gene networks. They may be closely related, and HOXA13 may serves as a biomarker to distinguish between IVL and UM.
Collapse
Affiliation(s)
- Xu Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Liangcai Wu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Rongjian Xu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chengpei Zhu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Guotao Ma
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chaoji Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xingrong Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Haitao Zhao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Qi Miao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| |
Collapse
|
31
|
Wu YH, Lee YT, Lee CI, Tzeng YH, Wei J. Nonthrombotic pulmonary embolism caused by intravenous leiomyomatosis: A case report. Medicine (Baltimore) 2019; 98:e14118. [PMID: 30653137 PMCID: PMC6370129 DOI: 10.1097/md.0000000000014118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
RATIONALE Pulmonary embolism is a potentially devastating medical condition. Although deep-vein thrombosis is the most common etiology, a nonthrombotic pulmonary embolism is not uncommon. PATIENT CONCERNS A 45-year-old woman was admitted to our hospital for progressive effort dyspnea for 3 weeks. DIAGNOSIS Echocardiography revealed a mobile mass extending from the right atrium to the bilateral proximal pulmonary artery. As the mass was no response to thrombotic therapy, intravenous leiomyomatosis was suspected. Computed tomography (CT) revealed a hypo-attenuated tumor extending from the ovarian vein to the pulmonary artery. INTERVENTIONS A 1-stage operation for the surgical removal of the tumor, right salpingo-oophorectomy and subtotal hysterectomy were performed. Surgical specimen was identified as uterine leiomyomatosis without malignant transformation. OUTCOMES The patient was followed- up for 2 years and subsequent CT did not reveal any notable lesions. LESSONS Nonthrombotic pulmonary embolism is a potentially life-threatening complication. This case indicated intravenous leiomyomatosis should be considered in the differential diagnosis for certain cases. Complete surgical excision was the only curative treatment.
Collapse
Affiliation(s)
- Yi-Hsiao Wu
- Department of Cardiovascular Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City
| | | | - Chuin-I Lee
- Department of Surgery, Da Chien General Hospital, Miaoli City
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging, Health Management Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng-Hsin General Hospital, Taipei
| |
Collapse
|
32
|
Yang C, Fang H, Yang Y, Cai F, Zheng H, Jin B, Li Y, Liu Z, Zayed MA. Diagnosis and surgical management of inferior vena cava leiomyomatosis. J Vasc Surg Venous Lymphat Disord 2018; 6:636-645. [DOI: 10.1016/j.jvsv.2018.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
|
33
|
Aguilar C, Espinoza D, Soca R. [Intravascular leiomyomatosis with intracardiac extension]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 51:183-187. [PMID: 30012312 DOI: 10.1016/j.patol.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
Intravascular leiomyomatosis is a rare condition characterized by histologically benign smooth muscle cell growth within the uterine veins and inferior vena cava and, rarely, into the right chambers of the heart. A 39-year-old female with a history of hysterectomy for uterine leiomyoma was admitted for lower limb oedema and progressive dyspnea of 5 months' duration. Transthoracic echocardiography and contrast-enhanced computed tomography showed a large mass extending through the inferior vena cava into the right chambers of the heart. As there was a suspicion of an intravenous thrombus, the patient underwent surgical resection. The histopathology of the resected mass led to a diagnosis of Intravascular leiomyomatosis with intracardiac extension.
Collapse
Affiliation(s)
- Cristian Aguilar
- Laboratorio de Anatomía Patológica, Instituto Nacional Cardiovascular, EsSalud, Lima, Perú.
| | - Daniel Espinoza
- Departamento de Cardiología, Instituto Nacional Cardiovascular, EsSalud, Lima, Perú
| | - Renzo Soca
- Departamento de Cardiología, Instituto Nacional Cardiovascular, EsSalud, Lima, Perú
| |
Collapse
|
34
|
Peña A, Tamaña M. Intracardiac extension of intravenous leiomyoma, a rare phenomenon: A case report. Radiol Case Rep 2018; 13:427-430. [PMID: 29904489 PMCID: PMC5999931 DOI: 10.1016/j.radcr.2018.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022] Open
Abstract
Leiomyoma of uterine origin is a common histologically benign neoplasm in women; however, growth intravenously with intracardiac extension is a rare phenomenon. This is a diagnostic challenge that can present with varied clinical manifestations and multiple differential diagnosis. This is a case of a 45-year-old female patient with chest heaviness and an intracardiac mass on 2-dimensional (2D) echocardiogram. Previous history of hysterectomy was likewise noted. Imaging workup, including 2D echocardiogram and contrast-enhanced chest and abdomen computed tomography scans, was performed which demonstrated a large, heterogeneous, elongated filling defect in the right atrium and right ventricle extending to the inferior vena cava, left renal vein, and left gonadal vein. The diagnosis was made after resection of the tumor in a single-stage operation. The histopathologic and immunoprofile of the resected tumor were consistent with leiomyoma. The use of multiple imaging modalities such as 2D echocardiogram and computed tomography are essential in the investigation of the intracaval masses with intracardiac extension. Although intravenous leiomyoma with intracardiac extension is a rare phenomenon, radiologists and clinicians alike should be mindful of this differential diagnosis.
Collapse
Affiliation(s)
- Aileen Peña
- Philippine Heart Center, East Avenue, Quezon City 0850, Philippines
| | - Marvin Tamaña
- Philippine Heart Center, East Avenue, Quezon City 0850, Philippines
| |
Collapse
|
35
|
Jalaguier-Coudray A, Allain-Nicolai A, Thomassin-Piana J, Villard-Mahjoub R, Delarbre B, Rua S, Lambaudie E, Houvenaeghel G. Radio-surgical and pathologic correlations of pelvic intravenous leiomyomatosis. Abdom Radiol (NY) 2017. [PMID: 28643137 DOI: 10.1007/s00261-017-1225-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intravenous leiomyomatosis has an unusual growth pattern characterized by proliferation of smooth muscle in uterine and systemic veins. Although histologically benign, this condition could eventually have a clinically aggressive course. At an early stage, the disease is often misdiagnosed on preoperative imaging because of its low prevalence, non-specific initial clinical manifestation, and poorly known radiological characteristics. An early, accurate diagnosis is needed for appropriate surgical management that could result in a good prognosis, reducing the risk of recurrence and morbidity. Magnetic resonance imaging is a particularly valuable technique for assessing intravenous leiomyomatosis preoperatively.
Collapse
Affiliation(s)
- A Jalaguier-Coudray
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France.
| | - A Allain-Nicolai
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France
| | - J Thomassin-Piana
- Department of Histopathology, Institute Paoli-Calmettes, Marseille, France
| | - R Villard-Mahjoub
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France
| | - B Delarbre
- Department of Radiology, Service d'Imagerie de la Femme, Institute Paoli-Calmettes, 232 boulevard Sainte-Marguerite, 13009, Marseille, France
| | - S Rua
- Department of Gynecology, Institute Paoli-Calmettes, Marseille, France
| | - E Lambaudie
- Department of Gynecology, Institute Paoli-Calmettes, Marseille, France
| | - G Houvenaeghel
- Department of Gynecology, Institute Paoli-Calmettes, Marseille, France
- CRCM and Université Aix-Marseille, Marseille, France
| |
Collapse
|
36
|
Castagneto Gissey L, Mariano G, Musleh L, Lepiane P, Colasanti M, Meniconi RL, Ranocchi F, Musumeci F, Antonini M, Ettorre GM. Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review. BMC Surg 2017; 17:118. [PMID: 29187188 PMCID: PMC5707788 DOI: 10.1186/s12893-017-0306-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine leiomyomas represent the gynecological neoplasm with the highest prevalence worldwide. This apparently benign pathological entity may permeate into the venous system causing the so-called intravenous leiomyomatosis of the uterus (IVL). IVL may seldom extend to large caliber veins and reach the right cardiac chambers or pulmonary arteries and cause signs of right sided congestive heart failure and sudden death. Due to its low incidence, however, IVL with intracardiac extension is often misdiagnosed resulting in deferred treatment. No consensus has been obtained regarding the standard surgical approach to be used for this rare condition. We describe the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and provide a review of the literature, analyzing management and surgical outcomes. CASE PRESENTATION We present the case of a 46-year-old premenopausal woman presenting with lower-extremity edema, recurrent syncopes and a history of subtotal hysterectomy for multiple uterine fibroids. She was diagnosed with pelvic recurrence of uterine leiomyomatosis and IVL with cardiac involvement. A two-stage surgical excision of the intracardiac-intracaval mass and pelvic leiomyomatosis was performed. The patient had an uneventful recovery and no evidence of recurrence was observed on follow-up. CONCLUSIONS By virtue of the rarity of the present pathology, awareness is widely scarce and diagnosis is often delayed. Early recognition is difficult due to initial aspecific and subtle clinical manifestations. Nevertheless, suspicion should be held high in premenopausal women with known history of uterine leiomyomata, presenting with cardiovascular symptoms and evidence of a free-floating mass within the right cardiac chambers. In-depth imaging is crucial for defining its anatomical origin and relations. Prompt surgical treatment with radical excision of pelvic and intravenous leiomyomatosis guarantees favorable outcomes and excellent prognosis with low rates of recurrence, whereas delayed diagnosis and treatment exposes to increased risk of congestive heart failure and sudden death.
Collapse
Affiliation(s)
- Lidia Castagneto Gissey
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy. .,Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Germano Mariano
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Layla Musleh
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Pasquale Lepiane
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Roberto L Meniconi
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Federico Ranocchi
- Department of Cardiac Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Mario Antonini
- Department of Anesthesia and Critical Care, INMI L. Spallanzani I.R.C.C.S, Rome, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| |
Collapse
|
37
|
Xu J, Wei M, Miao Q, Zhu B, Yu C, Huang Y. Perioperative management of intracardiac leiomyomatosis: An observational cohort study. Medicine (Baltimore) 2017; 96:e7522. [PMID: 28723765 PMCID: PMC5521905 DOI: 10.1097/md.0000000000007522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear.We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016.The mean patient age was 44.5 (range 25-55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived.Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible.
Collapse
Affiliation(s)
| | - Min Wei
- Department of Anesthesiology
| | - Qi Miao
- Department of Cardiac Surgery, Chinese Academy of Medical Sciences/Peking Union Medical College Hospital
| | - Bin Zhu
- Department of Anesthesiology, Peking University International Hospital, Beijing, P.R. China
| | | | | |
Collapse
|
38
|
Clinical characteristics and prognostic features of intravenous leiomyomatosis with inferior vena cava or intracardiac extension. J Vasc Surg Venous Lymphat Disord 2017. [PMID: 28623982 DOI: 10.1016/j.jvsv.2016.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to explore the clinical characteristics and prognostic features of intravenous leiomyomatosis (IVL) with inferior vena cava extension (IVCE) or intracardiac extension (ICE). METHODS A retrospective analysis was conducted of the clinical data of 38 patients with pathologically diagnosed IVL with IVCE or ICE. RESULTS The mean age of the patients was 44.05 ± 6.31 years. Twenty-two patients (57.9%) had a history of uterine leiomyoma. Nine patients (23.7%) had a history of IVL without IVCE or ICE. The most common symptoms were chest tightness (seven patients), lower limb swelling (five patients), palpitation (four patients), dizziness (two patients), and abdominal distention (two patients). Preoperative diagnoses were achieved in 28 patients (73.7%); 23 patients (60.5%) underwent one-stage surgery, whereas 15 (39.5%) underwent two-stage surgery. Eighteen patients (72%) received postoperative antiestrogen hormone therapy. Regular follow-up was available in 30 patients, with a median follow-up time of 12.0 months; 15 patients (50.0%) showed evidence of recurrence. Factors such as postoperative antiestrogen hormone therapy (9/20 compared with 6/10; P = .601), duration of postoperative hormonal therapy (10/15 in >6 months compared with 5/15 in ≤6 months; P = .862), and heart involvement (10/22 compared with 5/8; P = .669) were not significantly associated with recurrence. CONCLUSIONS IVL with IVCE or ICE is a rare disease with nonspecific manifestations. Surgery is the primary treatment. The postoperative recurrence rate is high, and postoperative antiestrogen hormone therapy is not significantly correlated with recurrence.
Collapse
|
39
|
Intracardiac Leiomyomatosis – an Unusual Cause of Syncope in a Middle-Aged Woman. Heart Lung Circ 2017; 26:e22-e25. [DOI: 10.1016/j.hlc.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/18/2016] [Indexed: 11/15/2022]
|
40
|
Schäfer HM, Isaak A, Gürke L. Case report of an intracaval leiomyomatosis 10 months after complete hysterectomy. Int J Surg Case Rep 2017; 35:1-3. [PMID: 28414995 PMCID: PMC5394212 DOI: 10.1016/j.ijscr.2017.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 11/27/2022] Open
Abstract
Intravenous leiomyomatosis within the vena cava can spread rapidly as far proximally as intracardially. Intravenous leiomyomatosis can be removed bluntly through cavotomy. Sternotomy can be avoided, reducing the surgery to a laparotomy.
Introduction Intravenous leiomyomatosis (IVL) is a rare smooth muscle tumor, usually found in women with tumors of the reproductive organs, such as uterus myomatosous. Surgically, this case belies the call for sternotomy and two-stage surgery in caval IVL extending to the right atrium: we suggest one-stage median laparotomy as a minimal procedure with maximal benefit. Presentation of case We present the case of a 60-year-old postmenopausal woman with suspected intravenous leiomyomatosis of the right internal iliac vein. The patient had undergone hysterectomy and bilateral adnexectomy for uterus myomatosous in September 2015, where an IVL limited to the veins of the uterus and the right adnex had been diagnosed. No further medical treatment had been implemented. IVL of the inferior vena cava was diagnosed when a CT scan of the abdomen was performed due to an infected abdominal seroma in June 2016. Although histologically benign, we found this case of IVL to be clinically aggressive because of its expansion to the heart. This may lead to thromboembolic complications (e.g. pulmonary embolism) or signs of right sided cardiac failure. The patient was asymptomatic, but because of the extension of the intracaval thrombus to the heart, we decided to operate and performed thrombectomy via a median laparotomy. The patient left the hospital shortly after on newly started oral anticoagulation. Discussion For caval IVL without intracardiac attachment, the extraction via laparotomy without sternotomy is the treatment of choice. It calls for an interdisciplinary approach and careful surgical planning. Conclusion There is no inherent need for sternotomy in IVL extending to the right atrium. A one-year follow-up with sonographic control is advised. Medium term oral anticoagulation should be considered. This work has been reported in line with the SCARE criteria Agha et al. (2016). The SCARE Statement: Consensus-based surgical case report guidelines. Agha RA, Fowler AJ, Saeta A, Barai I, Rajmohan S, Orgill DP; SCARE Group. Int J Surg. 2016 Oct;34:180-186 [1].
Collapse
Affiliation(s)
| | - Andrej Isaak
- University Hospital Basel, Vascular Surgery, Switzerland.
| | - Lorenz Gürke
- University Hospital Basel, Vascular Surgery, Switzerland.
| |
Collapse
|
41
|
Fang H, You Y, Cai F, Yang Y, Yang C, Lv P. Intravenous leiomyomatosis of the subclavian vein. J Vasc Surg Venous Lymphat Disord 2017; 5:254-256. [DOI: 10.1016/j.jvsv.2016.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
|
42
|
Zhang L, Duan Y, Song F, Xiao J, Yang B. Intravenous leiomyomatosis with right atrium extension in two patients: A case report. Mol Clin Oncol 2016; 5:604-606. [PMID: 27900095 DOI: 10.3892/mco.2016.1023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/08/2016] [Indexed: 11/06/2022] Open
Abstract
Intravenous leiomyomatosis (IVL) is a rare benign tumor of the uterus mesoderm, which can spread via the vein, from the micro-vein to the inferior vena cava, and even to the right atrium. IVL was first described this disease in 1896 and the first presented case of IVL with right atrium extension in the autopsy was described in 1907. On rare occasions, the tumors may extend into the regional and systemic veins, thus reaching the heart. This may subsequently cause intracardiac leiomyomatosis (ICL), which may lead to congestive heart failure and on occasion, sudden fatalities. Due to its rarity and diffuse symptoms, the misdiagnosis of ICL is common and as a result, the condition may be under-reported. The present study reported two cases of IVL resected at the General Hospital of Shenyang Military Command. A hysteromyomectomy for uterine fibroids was performed on each patient (Case 1, 41 years ago; Case 2, 3 years ago). One patient presented with chest pain following a period of activity and the other presented with heart neoplasm during a routine health examination.
Collapse
Affiliation(s)
- Lianxue Zhang
- Jinzhou Medical University, General Hospital of Shenyang Military Command Training Base for Graduate, Shenyang, Liaoning 110016, P.R. China
| | - Yang Duan
- Department of Radiology, General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China
| | - Fulin Song
- Department of Pathology, General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China
| | - Junrui Xiao
- Department of Radiology, General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Shenyang Military Command, Shenyang, Liaoning 110016, P.R. China
| |
Collapse
|
43
|
Ma G, Miao Q, Liu X, Zhang C, Liu J, Zheng Y, Shao J, Cheng N, Du S, Hu Z, Ren Z, Sun L. Different surgical strategies of patients with intravenous leiomyomatosis. Medicine (Baltimore) 2016; 95:e4902. [PMID: 27631266 PMCID: PMC5402609 DOI: 10.1097/md.0000000000004902] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is a rare benign tumor. The study aimed to assess outcomes of patients treated surgically for IVL.Between November 2002 and January 2015, 76 patients were treated for IVL. The stage of IVL was evaluated preoperatively by echocardiography and enhanced computerized tomography (CT) scan, and graded into 4 stages according to intravascular tumor progression. We recorded age, lower limb edema before surgery, surgical parameters, and hospitalization expenses. Patients were followed up every 6 months and tumor recurrence was assessed by CT and ultrasound. Patients were followed up for a mean of 4.5 ± 2.5 years (range 1-13 years) and there was no operative, hospital, or long-term mortality or were lost to follow-up.The rate of lower extremity edema, amount of blood loss, postoperative transfusion, length of intensive care unit (ICU) stay, postoperative hospitalization, and hospitalization expenses differed significantly between patients at different presurgery stages. Tumors recurred in 4 of 7 patients with stage I IVL that opted for surgery that preserved the ovaries and uterus. No recurrence was observed in patients graded stage II or more, in all of which the uterus and ovaries were removed. Recurrence was observed in only 4 of 76 cases of IVL, all of whom opted for surgery that spared the ovaries and uterus.Different surgical strategies should be decided based on the staging to completely remove the tumor and ensure the safety of patients. Removal of both ovaries is necessary for inhibiting tumor growth and avoiding recurrence.
Collapse
Affiliation(s)
- Guotao Ma
- Department of Cardiac Surgery
- Correspondence: Guotao Ma, Department of Cardiac Surgery, Peking Union Medical College Hospital, Beijing 100730, China (e-mail: )
| | - Qi Miao
- Department of Cardiac Surgery
| | | | | | | | | | | | | | | | - Zhan Hu
- Department of Surgery, Peking Union Medical College Hospital
| | - Zhinan Ren
- Department of Surgery, Peking Union Medical College Hospital
| | - Luxi Sun
- School of Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
44
|
Zhang G, Yu X, Lang J. Intravenous leiomyomatosis with inferior vena cava or intracardiac extension and concurrent bilateral multiple pulmonary nodules: A report of 2 cases. Medicine (Baltimore) 2016; 95:e4722. [PMID: 27583911 PMCID: PMC5008595 DOI: 10.1097/md.0000000000004722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Intravenous leiomyomatosis is a special type of uterine leiomyoma and features formation and growth of benign leiomyoma tissue within vascular wall. Benign metastatic leiomyoma refers to benign leiomyoma metastasizing to extra-uterine sites, dominantly lung. Solitary or multiple small nodules in the lung can be seen in image scans. METHODS We report 2 cases of intravenous leiomyomatosis with inferior vena cava or intracardiac extension and concurrent multiple nodules in bilateral lungs. RESULTS Case 1 was a 40-year-old woman with a large mass in pelvic cavity, masses in heart chambers, and disseminates pulmonary nodules detected at preoperative image scans. Masses in pelvic cavity and heart were resected in a 2-stage surgery. Histology examination confirmed the diagnosis of intravenous leiomyomatosis. Pulmonary nodules stayed stable during follow-up. Case 2 was a 37-year-old woman with 3 times of uterine-related surgeries. A pelvic mass appeared again and filling defect was observed in left ovarian vein, right renal vein, right common iliac vein, and inferior vena cava. Tumors in pelvic cavity and within vessels were removed in a 1-stage surgery. Histology examination confirmed the diagnosis of intravenous leiomyomatosis. Pulmonary nodules remained stable during follow-up. CONCLUSION The incidence of benign metastatic leiomyoma in patients with intravenous leiomyomatosis might be relatively high. Metastasis of intravenous leiomyomatosis lesions was a possible source of benign metastatic leiomyoma in these cases.
Collapse
Affiliation(s)
| | - Xin Yu
- Department of Obstetrics and Gynecology, Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Correspondence: Xin Yu, Department of Obstetrics and Gynecology, Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China (e-mail: )
| | | |
Collapse
|
45
|
Zeng H, Xu Z, Zhang L, Luo YI, Chen H, Zhu H, Peng L, Yu J. Intravenous leiomyomatosis with intracardiac extension depicted on computed tomography and magnetic resonance imaging scans: A report of two cases and a review of the literature. Oncol Lett 2016; 11:4255-4263. [PMID: 27313775 DOI: 10.3892/ol.2016.4499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/15/2016] [Indexed: 02/05/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is defined as a benign smooth muscle tumor, growing within systemic veins. IVL with intracaval and intracardiac extension has rarely been reported in radiological and oncological journals. The present study describes 2 cases of IVL extending from the inferior vena cava to the right atrium and ventricle, and discusses the imaging findings and differential diagnosis of this tumor entity. The two patients, who complained of palpitations, shortness of breath or syncope, were surgically treated, with complete resection of the cardiac and intracaval tumors. Pathological examinations were suggestive of IVL. The postoperative course of the two patients was uneventful, and no signs of recurrence were observed on follow-up. Computed tomography and magnetic resonance imaging played a vital role in the diagnostic process and presurgical assessment. The results of the present study indicate that IVL should be considered upon presentation of a soft mass in systemic veins, even when the mass extends to the right cardiac chambers, in female patients, particularly in patients with a history of uterine myoma.
Collapse
Affiliation(s)
- Hanjiang Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhongzi Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lizhi Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Y I Luo
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hui Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hongji Zhu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|
46
|
Knight J, Phillips DP, Esper SA, Zeh HJ, Badhwar V, Subramaniam K. Paradoxical Tumor Embolism and Recurrent Intracardiac Mass From Uterine Intravenous Leiomyomatosis. J Cardiothorac Vasc Anesth 2016; 31:642-645. [PMID: 27554224 DOI: 10.1053/j.jvca.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua Knight
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Dennis P Phillips
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Stephen A Esper
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Herbert J Zeh
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Vinay Badhwar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
47
|
Leiomiomatosis intravascular con extensión intracardiaca: cirugía abdominal y cardíaca en un solo tiempo. Cir Esp 2016; 94:306-7. [DOI: 10.1016/j.ciresp.2015.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022]
|
48
|
Li X, Xiao F, Yang Y, He Y, Zhang S. One-stage complete resection of giant intracardiac leiomyomatosis with moderate hypothermia extracorporeal circulation and beating heart technique with 36 months follow-up-a case report. J Cardiothorac Surg 2016; 11:64. [PMID: 27072649 PMCID: PMC4830041 DOI: 10.1186/s13019-016-0445-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intracardiac leiomyomatosis (ICL) is a rare benign neoplasm of the smooth muscle in the uterus extending into the heart. Complete resection is difficult because of the extensive range. CASE PRESENTATION We report a case of one-stage complete resection of a giant ICL with moderate hypothermia extracorporeal circulation and beating heart technique. CONCLUSIONS The outcome of 36 months follow-up was very good.
Collapse
Affiliation(s)
- Xihui Li
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China.
| | - Feng Xiao
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yindong He
- Department of Gynaecology, Peking University First Hospital, Beijing, China
| | - Siyu Zhang
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China
| |
Collapse
|
49
|
Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection. Int J Vasc Med 2015; 2015:756141. [PMID: 26783463 PMCID: PMC4689968 DOI: 10.1155/2015/756141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.
Collapse
|
50
|
Jain N, Rissam HK, Mittal UK, Sharma A. Intravenous leiomyomatosis with intracardiac extension: an unusual presentation of uterine leiomyoma and evaluation with 256-slice dual-source multidetector CT and cardiac MRI. BMJ Case Rep 2015; 2015:bcr-2015-211712. [PMID: 26643185 DOI: 10.1136/bcr-2015-211712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 40-year-old woman who presented with breathlessness, palpitations and vague pelvic pain for 6 months. The dyspnoea was non-exertional and episodic. She was a non-diabetic, non-hypertensive and had no history of prior surgeries. ECG and chest radiograph were normal. Cardiac MRI and 256-slice dual-source multidetector CT evaluation revealed the presence of a uterine and left adnexal mass with intravenous extension into the inferior vena cava via the gonadal veins, and further cephalad extension into the right atrium and ventricle. The patient was referred to the cardiothoracic surgery department and underwent two-stage surgical procedures. The first stage consisted of thoracotomy and tumour removal from the right atrium and inferior vena cava. In the second stage, hysterectomy and bilateral salpingo-oophorectomy was performed. The histological analysis of the excised specimen was consistent with an intravascular leiomyoma.
Collapse
Affiliation(s)
- Neeraj Jain
- Department of Radiology, GB Pant Hospital, New Delhi, India
| | | | - Umesh Kumar Mittal
- Department of Radiodiagnosis, GB Pant Institute of Post Graduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Sharma
- Department of Radiodiagnosis, GB Pant Hospital, New Delhi, India
| |
Collapse
|