Endometrial Stromal Sarcoma Metastatic from the Uterus to the Inferior Vena Cava and Right Atrium

Abstract

Endometrial stromal sarcoma metastases usually occur within the pelvis and rarely involve the great vessels or the heart. We present the case of a 55-year-old woman who was referred for endovascular therapy to treat presumed thrombosis of the inferior vena cava. The suspected thrombus was recalcitrant to endovascular removal with use of an AngioVac venous drainage device. Results of an intraprocedural transvenous biopsy revealed the mass to be the intravascular extension of an endometrial stromal sarcoma. The patient underwent surgical excision of the tumor, and, shortly thereafter, a hysterectomy and salpingo-oophorectomy. This complex case highlights both the rarity of malignancy masquerading as caval thrombus and the importance of multispecialty collaboration.

Low-grade endometrial stromal sarcoma with inferior vena cava tumor thrombus and intracardiac extension

“…When the metastatic cancer is observed from the heart, the most common site is right side like in our case [11,12].…”

Cardiac metastatic endometrial stromal sarcoma 17 years after hysterectomy

“…ESS accounts for less than 1% of all uterine tumors . The ESS is staged as IA (< 5 cm), IB (5 cm), IIA tumor limited to pelvic cavity but extended beyond the uterus, IIB pelvic cavity invasion, III tumor outside the pelvic cavity, IVA cavity invading the bladder, and metastasis IVB .…”

“…Surgery is the most important procedure in the management of these patients. Single‐stage or two‐stage operation with or without hypothermic circulatory arrest have been used for resection of the ESS with IVC and cardiac extension …”

“…Metastatic tumors to the heart may occur simultaneously or years later following a successful resection of the primary tumor . Endometrial stromal sarcoma (ESS) are uncommon, especially when they present as an isolated cardiac mass . We report a patient who presented with a right ventricular (RV) mass consistent with an ESS 17 years following a hysterectomy and radiation therapy for the same tumor.…”

“Raking-in Technique:” Removal Of Brachiocephalic Vein Thrombus Using AngioVac® Device Within A Stented Venous Segment

“…The versatility of this device has helped broaden the indications to include cardiac vegetations, tumor thrombus, and foreign body extractions 4, 5, 6. However, its main indication continues to be the removal of right atrial, saddle pulmonary and iliocaval emboli 7, 8, 9.…”