Intravenous leiomyomatosis without extrapelvic involvement

Mata, Rodrigo Pereira; Urzal, Cecília; Belo, Ana I.; Guerreiro, Fernando

doi:10.1136/bcr-2020-234864

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…The first description of this rare disease was by Birch-Hirschfeld in 1896. [ 2 ] 0.25% of uterine leiomyomas can have IVL as suggested by Ma et al ., in their series of 76 cases. [ 3 ] Although IVL is histologically benign, it can grow through the iliac or ovarian veins into the vena cava ultimately reaching the heart.…”

Section: Discussionmentioning

confidence: 99%

Intracardiac Leiomyomatosis Arising from a Uterine Leiomyoma – A Rare Case Requiring a Multidisciplinary Laparotomy–Thoracotomy Approach

Murali,

Thomas,

Pilllai

et al. 2023

Journal of Mid-Life Health

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A 37-year-old lady, when being evaluated in gynecology for pain in the abdomen, was found to have a pelvic mass suspicious of ovarian cancer with markers negative. There was an ovarian vein thrombosis extending to the right atrium in the contrast-enhanced computed tomography scan. A fluorodeoxyglucose positron emission tomography-computed tomography ruled out any other lesions. The patient underwent surgery under general anesthesia with transesophageal echocardiography to monitor the atrial thrombus. Intraoperatively, a retroperitoneal mass is seen arising from the right adnexal region of the uterus extending to the lumbar area. After the hysterectomy, bilateral salpingo-oophorectomy, tumor resection, and baring and looping of the retroperitoneal vessels, a sternotomy was done, and she was put on cardiopulmonary bypass. The tumor thrombus had two limbs both arising from the mass, one through the ovarian and the second through the iliac veins and joining together inside the inferior vena cava (IVC). With the excision of the ovarian vein at its junction, atrial incision, and incisions over the iliac veins and IVC, the thrombus was removed completely in a single sitting. Final histopathology revealed intravenous leiomyomatosis and no malignancy. We report this case as a rare disease, with both ovarian and iliac thrombus being a further rarity and a multidepartment joint effort with a successful outcome.

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Section: Discussionmentioning

confidence: 99%

Intracardiac Leiomyomatosis Arising from a Uterine Leiomyoma – A Rare Case Requiring a Multidisciplinary Laparotomy–Thoracotomy Approach

Murali,

Thomas,

Pilllai

et al. 2023

Journal of Mid-Life Health

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“…Hormonal medication might be considered in case of high risk of recurrence such as a big initial tumors size or incomplete surgical resection. Some study recommend the use hormonal therapy, especially if the patient is premenopausal, in case of recurrence or in order to reduce the tumor size if the patient reclines surgery [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , but the side effects of premature menopause have to be balanced with the eventual benefices of this medication [58] . A case with increase of tumor burden was described after Tamoxifen treatment emphasizing the necessity to consider carefully the indication of hormonal therapy [59] .…”

Section: Discussionmentioning

confidence: 99%

Intravenous leiomyomatosis: Case series and review of the literature

Mathey

Huber

2021

International Journal of Surgery Case Reports

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Introduction Intravenous leiomyomatosis (ILV) is a rare pathology, part of leiomyoma beyond the uterus (LBU), characterized by benign smooth muscle cell tumor outside of the uterus and mainly affecting premenopausal woman with a medical history of leiomyoma or gynecologic surgical treatment. The treatment depends on the localization of the tumor, age of the patient, initial size, symptoms and the suitability for surgery but should always aims in toto surgical resection. Case presentation Retrospective case series and review of literature. Clinical discussion Symptoms presented by the patient were aspecific and only localized in the pelvic area. All cases were fortuitous histopathological diagnosis. No relapse was. Two out of 5 patients have pulmonary nodules, only one was biopsied and diagnosed with PBML (pulmonary benign metastasizing leiomyoma). Conclusion IVL and BML are rare disease that can co-exist. Because of tumoral hormonal receptors, hormonotherapy could be an optional treatment but to date no clear efficacy is demonstrated. In case of high recurrence risk such as voluminous initial mass, impairment of broad ligament, failure of total surgical resection, adjuvant hormonotherapy could be useful. Recurrence rate is about 16.6-30% and can occur even dozen years later and even after radical surgery, justifying a regular follow up.

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“…When the tumor involves the inferior vena cava, heart, and even the lungs, lower extremity edema, difficult breathing, syncope, pulmonary embolism, and even sudden death can occur [ 32 ]. During the operation, the tumor can be found in the parauterine tissue, broad ligament, or uterine isthmus, and a worm-like tumor embolus can be seen in the myometrial vein or parauterine blood vessel, or a bead-like mass can be seen in the dilated pelvic blood vessel, and blood vessels should be monitored for suspected internal leiomyomas, the risk of surgery is often greater [ 32 ]. When a fibroid embolus is found in a blood vessel during surgery, robotic bipolar and grasping forceps should be used to peel the fibroids from the blood vessel ( Figure 9 A,B).…”

Section: Surgical Tips and Detailsmentioning

confidence: 99%

Tips and Details for Successful Robotic Myomectomy: Single-Center Experience with the First 125 Cases

Dou

Zhang

2022

JCM

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With the continuous development of minimally invasive and precise surgical techniques, laparoscopic myomectomy has become a mainstream surgical method due to its aesthetic outcomes and rapid postoperative recovery. However, during laparoscopic myomectomy, clinicians often encounter unfavorable factors, such as limited vision, inaccurate suturing, difficulty in removing tumors, and susceptibility to fatigue in the operating position. In recent years, robot-assisted surgery has been widely used in gynecology. The advantages of this technique, such as a three-dimensional surgical view, reducing the surgeon’s tremor, and the seven degrees of freedom of the robotic arms, compensate for the defects in laparoscopic surgery. The Department of Gynecology in our hospital has accumulated a wealth of experience since robot-assisted surgery was first carried out in 2017. In this article, the surgical skills of the robotic myomectomy process are described in detail.

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Intravenous leiomyomatosis without extrapelvic involvement

Cited by 4 publications

References 7 publications

Intracardiac Leiomyomatosis Arising from a Uterine Leiomyoma – A Rare Case Requiring a Multidisciplinary Laparotomy–Thoracotomy Approach

Intracardiac Leiomyomatosis Arising from a Uterine Leiomyoma – A Rare Case Requiring a Multidisciplinary Laparotomy–Thoracotomy Approach

Intravenous leiomyomatosis: Case series and review of the literature

Tips and Details for Successful Robotic Myomectomy: Single-Center Experience with the First 125 Cases

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