A contrast-enhanced CT-based radiomic nomogram for the differential diagnosis of intravenous leiomyomatosis and uterine leiomyoma

Ultrasound diagnostic value and clinical analysis of 61 uterine intravenous leiomyomatosis cases

Background

Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor, for which the ultrasound features and diagnostic value have rarely been reported due to its infrequent presentation. This study aimed to analyze ultrasonographic characteristics and diagnostic value of uterine IVL and explore risk factors influencing postoperative recurrence.

Methods

A retrospective analysis was conducted of 61 patients who underwent surgical treatment from December 2014 to December 2023. Intraoperative or postoperative pathology confirmed uterine IVL in these patients. Clinical data and ultrasonographic features were analyzed, including IVL location, the International Federation of Gynecology and Obstetrics (FIGO) classification, shape, involved vessels, extent of involvement, internal blood flow, and ultrasound diagnostic accuracy. Cumulative recurrence rates were calculated using Kaplan-Meier method, and the survival curves for clinical factors were analyzed. Prognostic analysis of IVL recurrence was performed using Cox proportional hazard model.

Results

The diagnostic accuracy of ultrasound for IVL was 55.7% (34/61). The diagnostic accuracy of ultrasound was 76.7% for para-uterine IVL (P<0.001), 76.9% for FIGO 8 category (P<0.001), 84.4% for cord-like or beaded morphology (P<0.001), 92.3% for the involvement of the iliac vessels or inferior vena cava (IVC, P=0.003), and 66.7% for abundant internal blood flow (P=0.213). During the follow-up period, IVL in 10 cases (16.4%) recurred. The cumulative recurrence rates were 10.5%, 12.8%, and 18% at 1, 2, and 3 years, respectively. Patients aged ≤46.5 years (P=0.010), with IVL involving the iliac vein or IVC (P=0.017), and undergoing myomectomy (P<0.001) had a higher recurrence rate. Univariate analysis identified age (≤46.5 years) (P=0.035), IVL involving the iliac veins or IVC (P=0.029), and myomectomy (P<0.001) as risk factors for recurrence. Multivariate analysis showed that IVL involving the iliac veins or IVC [P=0.021, hazard ratio (HR) 6.407] and myomectomy (P<0.001, HR 77.360) were independent risk factors for recurrence.

Conclusions

The diagnostic accuracy of ultrasound was high for IVL located adjacent to the uterus and in FIGO 8 category, especially when it presented with cord-like or beaded morphology and involved the iliac vessels or IVC. Involvement of the iliac veins or IVC and myomectomy were independent risk factors for IVL recurrence. The risk of recurrence for IVL involving the iliac veins or IVC was 6 times higher than that confined to the uterus or para-uterine veins, and the risk of recurrence was 77 times higher for myomectomy than for hysterectomy with bilateral oophorectomy.

Unraveling the challenges of intravenous leiomyomatosis: a retrospective analysis of 11 cases

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.

Update on clinical characteristics and molecular insights for uterine intravenous leiomyomatosis (Review)

Intravenous leiomyomatosis (IVL) is a rare benign disease, which typically develops along vascular vessels and extends to the inferior vena cava and right atrium of the heart. In the early stages of the disease, the clinical manifestations and the results of imaging examinations are not uniform among patients. Thus, a high rate of misdiagnosis and missed diagnosis is common. When the tumor extends along the venous system to the pelvic floor vein or through the inferior vena cava involving the right atrium of the heart or the pulmonary artery, severe symptoms occur, such as ascites, dyspnea, heart failure and even sudden mortality. Improving the understanding of IVL to identify and evaluate this disease in its early stages is important. Complete tumor resection remains the primary treatment option for IVL. The recurrence rate of the disease varies depending on multiple factors, such as type of surgical procedure performed. Therefore, long-term follow-up is necessary for patients with IVL. The review of recent findings on the molecular and clinicopathological characterization of IVL is important to understand the pathogenesis of IVL. In the present study, the clinical manifestations, pathogenesis, differential diagnosis, treatment and prognosis of IVL are summarized in order to provide a single source of insightful information on IVL.