Intravenous leiomyomatosis extending to the heart

Polizzi, Vincenzo; Pergolini, Amedeo; Zampi, Giordano; Presti, M Lo; Pino, Paolo Giuseppe; Cartoni, Domenico; Sbaraglia, Fabio; Vallone, Andrea; Ettorre, Giuseppe Maria; Musumeci, Francesco

doi:10.1007/s00059-013-3862-7

Cited by 3 publications

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“…We therefore opted for a staged approach. Conversely, we have previously reported the case of a female patient presenting with an analogous condition where a one-stage procedure was adopted, in view of the inferior complexity of the pelvic component [ 18 ]. The patient has completed now a 36 month follow-up and has shown no evidence of disease.…”

Section: Discussionmentioning

confidence: 99%

Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

et al. 2017

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BackgroundUterine 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 presentationWe 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.ConclusionsBy 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.Electronic supplementary materialThe online version of this article (10.1186/s12893-017-0306-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

et al. 2017

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“…Vascular ultrasonography is important for the diagnosis of IVL and can provide information about intravascular thrombosis The main feature is a cord-like inhomogeneous substantive echo from the inferior vena cava extending to the right cardiac cavity with a clear boundary in the vessel and in the cardiac cavity (24).…”

Section: Vascular Ultrasonographymentioning

confidence: 99%

Complete intravenous leiomyomatosis: a case report and literature review

Wei¹,

Ji²,

Zhang³

et al. 2021

Ann Palliat Med

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Clinical features and prognostic factors analysis of intravenous leiomyomatosis

Chen

Zhang

et al. 2023

Front. Surg.

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BackgroundThe treatment and prognostic factors of intravenous leiomyomatosis (IVL) remain lacking systematic evidence.MethodsA 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.ResultsA 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.ConclusionPatients 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.

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Intravenous leiomyomatosis extending to the heart

Cited by 3 publications

References 0 publications

Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

Complete intravenous leiomyomatosis: a case report and literature review

Clinical features and prognostic factors analysis of intravenous leiomyomatosis

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