1
|
Petitjean M, Kashi-Dakhil M, Hachemane S, Dakhil B, Zaimi R, Bagan P. [Leiomyosarcoma and angiomyomatous hamartoma: An hasardous association?]. Bull Cancer 2020; 107:1081-1084. [PMID: 32950243 DOI: 10.1016/j.bulcan.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Margaux Petitjean
- Hôpital Victor-Dupouy, service de chirurgie thoracique et vasculaire, 69, rue du lieutenant-colonel Prudhon, bâtiment Madeleine Brès, 95107 Argenteuil, France.
| | - Mahine Kashi-Dakhil
- Hôpital Victor-Dupouy, service de chirurgie thoracique et vasculaire, 69, rue du lieutenant-colonel Prudhon, bâtiment Madeleine Brès, 95107 Argenteuil, France
| | - Samia Hachemane
- Hôpital Victor-Dupouy, service d'anatomopathologie, 69, rue du lieutenant-colonel Prudhon, 95107 Argenteuil, France
| | - Bassel Dakhil
- Hôpital Victor-Dupouy, service de chirurgie thoracique et vasculaire, 69, rue du lieutenant-colonel Prudhon, bâtiment Madeleine Brès, 95107 Argenteuil, France
| | - Rym Zaimi
- Hôpital Victor-Dupouy, service de chirurgie thoracique et vasculaire, 69, rue du lieutenant-colonel Prudhon, bâtiment Madeleine Brès, 95107 Argenteuil, France
| | - Patrick Bagan
- Hôpital Victor-Dupouy, service de chirurgie thoracique et vasculaire, 69, rue du lieutenant-colonel Prudhon, bâtiment Madeleine Brès, 95107 Argenteuil, France
| |
Collapse
|
2
|
Rosenfeld BL, Bashir R, Brisco-Bacik MA, Panidis IP, Vaidya A, Minakata K, Forfia PR. Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921124. [PMID: 32345956 PMCID: PMC7209904 DOI: 10.12659/ajcr.921124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as "thrombus in transit." CASE REPORT The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as "thrombus in transit", this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma. CONCLUSIONS With rare exceptions, "thrombus in transit" is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radiographic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism.
Collapse
Affiliation(s)
- Benjamin L Rosenfeld
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Riyaz Bashir
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | | | - Ioannis P Panidis
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Anjali Vaidya
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Kenji Minakata
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Paul R Forfia
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| |
Collapse
|
3
|
Yedururi S, Kang H, Cox VL, Chawla S, Le O, Loyer EM, Marcal L. Tumor thrombus in the venous drainage pathways of primary, recurrent and metastatic disease on routine oncologic imaging studies: beyond hepatocellular and renal cell carcinomas. Br J Radiol 2019; 92:20180478. [PMID: 30844299 DOI: 10.1259/bjr.20180478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Radiologists routinely evaluate for tumor thrombus in the portal and hepatic veins in patients with hepatocellular carcinoma and in the renal vein and inferior vena cava in patients with renal cell carcinoma. However, tumor thrombus occurs in association with numerous other tumor types, e.g. colorectal carcinoma and pancreatic neuroendocrine tumor. Furthermore tumor thrombi are not limited to the primary tumor but also seen with local recurrence and metastatic disease. While less recognized, these thrombi nevertheless affect patterns of recurrence and prognosis. Their detection is critical for accurate local staging and early detection of local recurrence and metastatic disease. The purpose of this pictorial review is to draw the attention of radiologists to the less familiar manifestations of tumor thrombus, review the imaging findings and illustrate the clinical significance of these thrombi.
Collapse
Affiliation(s)
- Sireesha Yedururi
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| | - HyunSeon Kang
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| | - Veronica L Cox
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| | - Sumedha Chawla
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| | - Ott Le
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| | - Evelyne M Loyer
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| | - Leonardo Marcal
- 1 Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center Houston , Texas , USA
| |
Collapse
|
4
|
Bois MC, Eckhardt MD, Cracolici VM, Loe MJ, Ocel JJ, Edwards WD, McBane RD, Bower TC, Maleszewski JJ. Neoplastic embolization to systemic and pulmonary arteries. J Vasc Surg 2018; 68:204-212.e7. [PMID: 29502997 DOI: 10.1016/j.jvs.2017.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/23/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens. METHODS Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016). RESULTS Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%. CONCLUSIONS This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.
Collapse
Affiliation(s)
- Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Michael D Eckhardt
- Department of Pathology and Laboratory Medicine, University of Chicago, NorthShore University HealthSystem, Evanston, Ill
| | | | - Matthew J Loe
- Interventional Radiology, St. Paul Radiology, St. Paul, Minn
| | - Joseph J Ocel
- Diagnostic Radiology, Mercy Health Services-Iowa Corporation, Mason City, Iowa
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
| |
Collapse
|
5
|
Latchana N, Daniel VC, Gould RW, Pollock RE. Pulmonary tumor embolism secondary to soft tissue and bone sarcomas: a case report and literature review. World J Surg Oncol 2017; 15:168. [PMID: 28854949 PMCID: PMC5577830 DOI: 10.1186/s12957-017-1223-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background Tumor embolisms (TE) are an underappreciated source of pulmonary embolisms in sarcoma. Most evidence in the literature is limited to case reports and none have described the presence of TE secondary to myxofibrosarcoma. We report the first case of myxofibrosarcoma TE and perform a review of the literature for TE secondary to bone and soft tissue sarcomas (STS). Case presentation A 36-year-old female presented with debilitating pain of the right upper extremity secondary to a recurrent soft tissue sarcoma. She had distant metastasis to the lung. An MRI revealed a 25-cm shoulder mass involving the proximal arm muscles with encasement of the axillary artery, vein, and brachial plexus. A palliative forequarter amputation was performed and tumor thrombus was evident within the axillary artery and vein. Postoperatively, she developed an acute onset of dyspnea and hypoxia. A computed tomography scan revealed a pulmonary saddle embolism. A bilateral lower extremity venous duplex was negative. She became hemodynamically unstable despite resuscitation and was placed on vasopressor support. A transthoracic echocardiogram revealed elevated pulmonary artery pressure, tricuspid regurgitation, right heart dilation, and reduced right heart systolic function consistent with acute cor pulmonale. The patient did not want to pursue a median sternotomy with pulmonary artery embolectomy and expired from cardiopulmonary arrest within 24 h of the operation. The final pathology revealed a 25 × 16 × 13 cm high-grade myxofibrosarcoma with invasion into the bone, skin, and neurovascular bundle as well as evidence of tumor thrombus. Conclusion TE is a rare but deadly cause of pulmonary embolism in sarcoma. A high index of suspicion is necessary in individuals who present with respiratory-related symptoms, especially dyspnea. Diagnostic confirmation with a computed tomography scan of the chest and echocardiogram should be rapid. Unlike venous thromboembolism, pulmonary embolectomy remains the preferred therapeutic approach. Electronic supplementary material The online version of this article (doi:10.1186/s12957-017-1223-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicholas Latchana
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Robert W Gould
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raphael E Pollock
- Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada. .,Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute Center, 410 W. 10th Ave, N924 Doan Hall, Columbus, OH, 43210, USA.
| |
Collapse
|
6
|
Peripheral Non-atherosclerotic Arterial Disorders: What Radiologists Need to Know. Acad Radiol 2017; 24:497-505. [PMID: 27940229 DOI: 10.1016/j.acra.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 12/24/2022]
Abstract
Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.
Collapse
|
7
|
Zeng H, Xu Z, Zhang L, Luo YI, Chen H, Zhu H, Peng L, Yu J. Intravenous leiomyomatosis with intracardiac extension depicted on computed tomography and magnetic resonance imaging scans: A report of two cases and a review of the literature. Oncol Lett 2016; 11:4255-4263. [PMID: 27313775 DOI: 10.3892/ol.2016.4499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/15/2016] [Indexed: 02/05/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is defined as a benign smooth muscle tumor, growing within systemic veins. IVL with intracaval and intracardiac extension has rarely been reported in radiological and oncological journals. The present study describes 2 cases of IVL extending from the inferior vena cava to the right atrium and ventricle, and discusses the imaging findings and differential diagnosis of this tumor entity. The two patients, who complained of palpitations, shortness of breath or syncope, were surgically treated, with complete resection of the cardiac and intracaval tumors. Pathological examinations were suggestive of IVL. The postoperative course of the two patients was uneventful, and no signs of recurrence were observed on follow-up. Computed tomography and magnetic resonance imaging played a vital role in the diagnostic process and presurgical assessment. The results of the present study indicate that IVL should be considered upon presentation of a soft mass in systemic veins, even when the mass extends to the right cardiac chambers, in female patients, particularly in patients with a history of uterine myoma.
Collapse
Affiliation(s)
- Hanjiang Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhongzi Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lizhi Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Y I Luo
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hui Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hongji Zhu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|
8
|
Srettabunjong S, Chuangsuwanich T. Inferior Vena Cava Tumor Thrombosis Secondary to Metastatic Uterine Cancer: A Rare Cause of Sudden Unexpected Death. J Forensic Sci 2016; 61:555-558. [PMID: 27404631 DOI: 10.1111/1556-4029.13032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/08/2015] [Indexed: 11/30/2022]
Abstract
Pulmonary tumor thromboembolus (PTTE) secondary to uterine cancer is a rare cause of sudden unexpected deaths in the elderly population. Additionally, tumor extension to the inferior vena cava (IVC) makes it rarer. No such cases have been previously reported in the forensic literature. We report this phenomenon in a previously healthy 70-year-old woman with no other known risk factors for the development of deep vein thrombosis. The deceased was found dead while watching television with her relatives. Autopsy examination revealed that her death was attributed to a saddle embolus lodged in the main pulmonary arteries. A uterine tumor was discovered, and microscopic examination revealed low-grade endometrial stromal sarcoma with angiolymphatic invasion. The tumor cells were also found in the embolus and the remnant thrombosis attached to the inner wall of the IVC. This case demonstrates a sudden unexpected death caused by acute PTTE following seeding of uterine cancer into the IVC and raises awareness of such events.
Collapse
Affiliation(s)
- Supawon Srettabunjong
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Tuenjai Chuangsuwanich
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| |
Collapse
|
9
|
Gui T, Qian Q, Cao D, Yang J, Peng P, Shen K. Computerized tomography angiography in preoperative assessment of intravenous leiomyomatosis extending to inferior vena cava and heart. BMC Cancer 2016; 16:73. [PMID: 26858203 PMCID: PMC4746779 DOI: 10.1186/s12885-016-2112-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravenous leiomyomatosis (IVL) extending to inferior vena cava and heart is one of the most challenging conditions for surgical treatment. We explored the use of computerized tomography angiography (CTA) in preoperative assessment for this disease. METHODS A cohort of 31 patients with IVL extending to inferior vena cava and heart were reviewed from the year 2002 to 2014, focusing on the preoperative CTA imaging characteristics and the surgical procedures in clinical treatment. RESULTS All patients were diagnosed correctly combining the clinical medical history and CTA imaging. Thirteen patients had tumors confined within the inferior vena cava, and 18 patients had tumors intruding into the right heart. Furthermore, 15 tumors were located in the right atrium alone, and 3 tumors involved both the right atrium and the right ventricle. All patients had simple or multiple soft tissue masses from the pelvis, with 22 tumors extending into inferior vena cava through the iliac veins and 9 tumors through the ovarian veins. Three patients had tumors invading into lung and underwent tumor thrombus resection in the pulmonary artery. Patients received either one-stage surgery or two-stage surgery dependent on patient general condition and tumor status. All operations were successfully performed by multidisciplinary cooperation, including gynecology, cardiac surgery, and vascular surgery, without severe surgical-related complications or deaths. CONCLUSIONS CTA imaging can present location, size, and full-scale extension pathway of IVL lesions, and can be used as first-line imaging technique in preoperative assessment, having great significance in making surgical plan and obtaining successful outcome.
Collapse
Affiliation(s)
- Ting Gui
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Qiuhong Qian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Ping Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| |
Collapse
|
10
|
Lim YH, Lee LS, Lim CH, Chew GK. Successful removal of uterine leiomyosarcoma tumour thrombus propagating to the right atrium. BMJ Case Rep 2015; 2015:bcr-2015-213384. [PMID: 26607197 DOI: 10.1136/bcr-2015-213384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although 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.
Collapse
Affiliation(s)
- Yu Hui Lim
- Department of Obstetrics and Gynaecology, Singhealth, Singapore, Singapore
| | | | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
| | - Ghee Kheng Chew
- Department of Obstetrics and Gynaecology, Singhealth, Singapore, Singapore
| |
Collapse
|
11
|
Kuo PL, Lee TY, Wu MT, Wu FZ. Endometrial Stromal Sarcoma with Intravenous and Cardiac Extension. Heart Lung Circ 2015; 24:e220-1. [PMID: 26375498 DOI: 10.1016/j.hlc.2015.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Pei-Lun Kuo
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tao-Yu Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Section of Thoracic and Circulation Imaging, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Fu-Zong Wu
- Department of Radiology, Section of Thoracic and Circulation Imaging, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
| |
Collapse
|
12
|
Successful multiple-step management of intravenous leiomyomatosis diagnosed after episode of acute abdominal pain: Case report and review of literature. Int J Surg Case Rep 2015; 14:176-8. [PMID: 26282558 PMCID: PMC4573866 DOI: 10.1016/j.ijscr.2015.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 11/24/2022] Open
Abstract
Intravenous leiomyomatosis could be defined as the extrauterine extension of smooth-muscle cells. IVL causes systematic complications and is characterized by increased possibility of recurrence. Diagnosis is an issue of high clinical difficulty. Surgical resection of IVL either in one or in multiple-step strategy remains the optimal approach.
Introduction We present the case of a 37-year old woman diagnosed with intravenous leiomyomatosis (IVL) that was managed uneventfully with multiple-step management. Presentation of case A 37-year-old woman was admitted because of acute abdominal pain. Emergency Computed Tomography demonstrated a big pelvic mass 5 × 15 cm of heterogenous composition intaking the contrast agent. Total hysterectomy with salpingoophorectomy was proposed to patient, however, patient expressed her will for fertility preservation and gave consent only for the resection of a single ovary. Laparotomy revealed the presence of myoma, multiple lesions of potential adenomyosis and cordon-shaped formations arising from uterus and extending mainly to left ovary. Final histological diagnosis was intravenous leiomyomatosis (IVL). MRI angiography revealed the presence of residual lesions in inferior vena cava. Laparoscopic resection was performed one month after laparotomy and left ovary was resected without complications. Venovenous bypass was finally performed three months later from initial surgery. The process was significantly labored, resulted in the successful resection of intravenous lesions but was complicated intraoperatively by right kidney rupture. After a follow-up of 33 months, case remains uncomplicated without signs or symptoms of potential recurrence. Discussion Intravenous leiomyomatosis represents a rare clinical entity histologically bening but clinically aggressive. No consensus exists regarding the optimal management, especially in cases with initial will for fertility preservation. Conclusion IVL represents a rare clinical entity often presenting difficulties in diagnosis and optimal treatment. Large case-series studies should be encouraged to assess the optimal management.
Collapse
|
13
|
Uterine myxoid leiomyosarcoma with tumor embolism extending into the right atrium. Case Rep Obstet Gynecol 2015; 2015:316262. [PMID: 25722901 PMCID: PMC4333190 DOI: 10.1155/2015/316262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 12/26/2022] Open
Abstract
Uterine myxoid leiomyosarcoma (MLMS) is an extremely rare variant of uterine leiomyosarcoma; only 56 cases were reported from 1982 to 2013. Uterine MLMS is characterized by a myxoid appearance and highly malignant behavior. We herein report a case involving a 65-year-old woman with uterine MLMS with a large tumor embolism that reached the right atrium. A total abdominal hysterectomy, bilateral salpingooophorectomy, and tumor embolism resection with the use of a heart-lung machine were performed. Epirubicin-ifosfamide chemotherapy in the adjuvant setting led to reductions in both the tumor emboli and peritoneal dissemination. The patient retained a good quality of life for 10 months after the initial surgery. She then developed progressive disease despite treatment with pazopanib. She died of her disease 14 months after the initial surgery. Although complete surgical resection of the tumor is desirable, tumor reduction surgery followed by adjuvant chemotherapy might help to retain a good quality of life. This is the first reported case of a primary uterine MLMS with tumor emboli.
Collapse
|
14
|
Mckenna LR, Jones EL, Jones TS, Nydam T, Gajdos C. Recurrent intravenous leiomyosarcoma of the uterus in the retrohepatic vena cava. J Surg Case Rep 2014; 2014:rju090. [PMID: 25204766 PMCID: PMC4158174 DOI: 10.1093/jscr/rju090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although intravenous extension of uterine leiomyosarcomas has been described, extension into the inferior vena cava (IVC) and right atrium, so-called ‘intravenous leiomyosarcomatosis (IVLS)’, is rare. To our knowledge only a few cases have been described in the literature. We describe a case of recurrent uterine leiomyosarcoma to the retrohepatic IVC. The patient was initially treated with total abdominal hysterectomy. Follow-up computed tomography a year later showed an extensive intravascular and intracardiac soft tissue mass treated with tumor extraction using cardiac bypass. Five years later she presented to our institution with a new retrohepatic caval mass treated with surgical resection and caval grafting. IVLS is a rare disease that is best treated with surgical resection even in the recurrent setting. The role of adjuvant therapy remains unclear.
Collapse
Affiliation(s)
- Logan R Mckenna
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Teresa S Jones
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Trevor Nydam
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Csaba Gajdos
- Department of Surgery, University of Colorado, Aurora, CO, USA
| |
Collapse
|
15
|
Mendivil AA, Cupp JS, Van Dalsem W, Caffarelli A, Goldstein BH. Multidisciplinary treatment of pelvic and cardiac intravenous leiomyosarcomatosis. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 6:16-8. [PMID: 24371709 PMCID: PMC3862305 DOI: 10.1016/j.gynor.2013.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/02/2013] [Indexed: 11/25/2022]
Abstract
Intravenous leiomyosarcomatosis is a rare condition in which malignant myometrial tissue metastasizes to the heart. We discuss the complicated diagnosis and treatment of a patient afflicted with intravenous leiomyosarcomatosis. To ensure a favorable prognosis, therapy should comprise comprehensive and multi-disciplinary treatment.
Collapse
Affiliation(s)
| | - John S Cupp
- Hoag Memorial Hospital Presbyterian, Department of Pathology, Newport Beach, CA 92663, USA
| | | | - Anthony Caffarelli
- Hoag Memorial Hospital Presbyterian, Department of Cardiovascular and Thoracic Surgery, USA
| | | |
Collapse
|
16
|
Tierney KE, Rogers A, Mhawech-Fauceglia P, Lin YG. Recurrent leiomyosarcoma presenting as malignant arterial tumor thrombus. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 4:32-4. [PMID: 24371672 DOI: 10.1016/j.gynor.2012.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/28/2012] [Indexed: 11/18/2022]
Abstract
► The report reviews unique arterial embolic phenomena in the context of newly diagnosed recurrent leiomyosarcoma. ► Metastatic work-up should be initiated in those diagnosed with malignant arterial tumor emboli.
Collapse
Affiliation(s)
- Katherine E Tierney
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Anna Rogers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Paulette Mhawech-Fauceglia
- Department of Pathology, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA
| | - Yvonne G Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
17
|
Abstract
Intravenous leiomyomatosis (IVL) is a rare smooth muscle tumor. Although IVL is histologically benign, it might be aggressive in its behavior and can grow into pelvic veins and the inferior vena cava (IVC) extending into the heart chambers and pulmonary vasculature. Occasionally, it was found to have lung metastasis. We describe four cases of IVL in the IVC with a history of hysterectomy for uterine leiomyoma, one extending into the left renal vein and three growing into the right heart chamber. We report the computed tomography (CT) findings in the four cases and briefly discuss the CT features of IVL in order to help making accurately preoperative diagnosis and improve the rate of surgical resection and survival.
Collapse
Affiliation(s)
- Hong-Juan Peng
- Shandong University, Shandong Provincial Medical Imaging Institute, Jinan, People's Republic of China.
| | | | | | | | | | | |
Collapse
|
18
|
Moniaga NC, Randall LM. Uterine leiomyomatosis with intracaval and intracardiac extension. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:130-2. [PMID: 24371644 DOI: 10.1016/j.gynor.2012.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 08/25/2012] [Indexed: 12/01/2022]
Abstract
► Intravenous leiomyomatosis is histologically benign, but biologically aggressive. ► No diagnostic tools reliably distinguish it from leiomyosarcoma prior to surgery. ► Complete resection is curative, but antiestrogens can stabilize disease.
Collapse
Affiliation(s)
- Natalie C Moniaga
- Orange, CA, Department of Obstetrics and Gynecology, University of California, Irvine, USA
| | - Leslie M Randall
- Orange, CA, Department of Obstetrics and Gynecology, University of California, Irvine, USA
| |
Collapse
|
19
|
|
20
|
Pradhan S, Bazan H, Salem R, Gusberg RJ. Intravenous lobular capillary hemangioma originating in the iliac veins: a case report. J Vasc Surg 2008; 47:1346-9. [PMID: 18514851 DOI: 10.1016/j.jvs.2008.01.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 01/24/2008] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
Abstract
Intravenous lobular capillary hemangioma is a rare benign lesion that can mimic other intravascular lesions encountered by vascular surgeons, such as angiosarcoma, papillary endothelial hyperplasia, and deep vein thrombus. These lesions have been described originating in the veins of the head, neck, and upper extremities. To our knowledge, there are no reported cases of intravenous capillary hemangioma arising from within a pelvic vein. We report a case of an elderly woman found to have an extensive intravenous lobular capillary hemangioma originating in the internal iliac vein. She was successfully treated with resection, including the tumor and normal iliac vein. Diagnosis of these lesions can be difficult. We describe the utility of duplex ultrasound and magnetic resonance venography in aiding preoperative diagnosis and surgical planning. The diagnosis is ultimately confirmed with histology that demonstrates multiple capillaries lined with flattened endothelial cells grouped in a lobular fashion admixed with fibromyxoid stroma containing collagenous fibers, spindle cells, and mitotic figures. Preoperative work-up should include a duplex ultrasound and magnetic resonance venogram. Treatment should be with resection and specimen processing to rule-out malignant vascular tumors.
Collapse
Affiliation(s)
- Sanjeev Pradhan
- Department of Surgery, Sections of Vascular Surgery and Surgical Oncology, Yale University Medical School and Yale-New Haven Hospital, New Haven, CT, USA.
| | | | | | | |
Collapse
|