A Case of One-stage Surgery for Intravenous Leiomyomatosis Extending from the Internal Iliac Vein to the Right Atrium

Abstract

The case was that of a 47-year-old woman with a mobile tumor detected in the inferior vena cava on ultrasonography performed during a medical examination. Detailed examination revealed a mass extending its entire length from the right internal iliac vein to the inferior vena cava. Thrombosis was suspected, and the patient was treated with anticoagulation therapy. However, no change in the tumor mass was observed. Complete resection of tumor was indicated, because of the possibility of a tumor growth or pulmonary embolism. Initially, the mass was determined to be resectable with laparotomy alone. However, a transesophageal ultrasonographic examination performed immediately before the operation revealed that the tumor had adhered to the wall of the right atrium. Thus, the tumor was completely resected in a one-stage surgery with thoractomy and laparotomy combined with extracorporeal circulation and occulusion balloon catheter. The pathological diagnosis was intravenous leiomyomatosis. The postoperative progress was uneventful. The patient has had no recurrence and is currently under observation 2 years after surgery.