A Challenging Case of Intracardiac Leiomyomatosis Accompanied by Pseudo-Meigs Syndrome Originating from Uterine Leiomyoma

Combined transthoracic echocardiography and contrast‐enhanced ultrasonography to trace intravenous leiomyomatosis with intracardiac extension

“…Histologically, IVL resembles typical benign uterine leiomyomas at both the gross and microscopic levels, but with atypical aggressive growth and expansion . It has led to controversy regarding their pathogenesis, diagnosis, and treatment …”

“…2,6 It has led to controversy regarding their pathogenesis, diagnosis, and treatment. 7,8 In such patients, who are IVL with intracardiac extension, it may be misdiagnosed and treated improperly because these patients usually present only cardiac symptoms. The diagnosis can be confused with intracardiac thrombosis, myxoma, and the terminal stage of malignant tumors.…”

The role of estrogen deprivation therapy in premenopausal women with primary unresectable intracardiac leiomyomatosis: a systematic review and meta-analysis

“…However, complete resection cannot be performed in many cases for extension of tumors [5,24,27,37], densely adherent to the luminal wall [4, 5, 7, 13-16, 19-22, 41, 42], and patients' will [27,28], or constrained medical resources. In such conditions, recurrence occurred postoperatively [4,9,10,12,15,21,22,24], lethal complications such as uncontrolled hemorrhage [20,42], heart failure, and sudden death happened [3,7]. The complete resection rate was significantly lower in patients with firm/extensive adhesion than that in those with no/slight adhesion of IVC or above (Table 2).…”

“…The gentle downward extraction via venotomy of the iliac /IVC veins even without sternotomy could be performed successfully in patients had no/slight adhesion and had no pulmonary nodules [30,31]. In contrast, the intracaval tumor of some patients were failed to be pulled out due to firmly adhesion [7,14,19,20]. And torn traction in the IVC occurred in one of them, leading to severe bleeding and death during operation [7].…”

“…Treatment for ICLM varied because of its rarity and complexity, which included surgeries [12][13][14], anti-estrogen hormone therapies [9,12,15], and even a wait-andsee strategy [1,16]. Complete tumor resection was the most recommended [17,18], but sometimes it cannot be achieved due to the high risks of surgery [5,7,13,15,16,[19][20][21][22], patient's poor conditions [4,12,23,24], lack of medical resources [25], financial constraints [2,26], or patients' refusal [27,28].…”