Successful removal of uterine leiomyosarcoma tumour thrombus propagating to the right atrium

Abstract

SUMMARYAlthough intravenous leiomyomatosis is widely documented, intravenous extension of leiomyosarcoma into the inferior vena cava (IVC) and subsequently into the right atrium is extremely rare. Less than five such cases have been reported in the literature worldwide. Uterine leiomyosarcoma is an aggressive smooth muscle tumour occurring with an incidence of 1% in all female genital tract cancers and comprises about 3-7% of uterine cancers. It carries a generally poor prognosis with 5-year survival rates ranging from 18.8% to 65% across all stages. We report a case of primary uterine leiomyosarcoma with intravascular tumour propagation extending to the renal vein, IVC and right atrium of the heart, which was successfully resected in a one stage operation by a multidisciplinary team. This case demonstrates the importance of preoperative radiological staging and multidisciplinary planning. BACKGROUND

Unresectable Leiomyosarcoma Of The Inferior Vena Cava With Right Atrium Tumor Thrombus: When To Deem This Tumor Inoperable? A Case Report And Literature Review.

“…The largest case series by Perhavec et al showed the most common reasons for technical unresectability to be the involvement of the superior mesenteric vessels, followed by the involvement of bone, portal vein, or hepatic axis (8). When managing an intracardiac tumor thrombus, wide resection is still preferred and intra-operative cardiopulmonary bypass should be considered to facilitate resection and maintain organ perfusion (20)(21)(22) Their rarity poses a great oncologic and surgical challenge, as the bene ts of systemic treatment are unde ned, and surgical management remains controversial. Neoadjuvant therapy can be used to reduce tumor size and improve resectability.…”