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Law YJ, Hines EM, Frahm-Jensen G. Images in Vascular Medicine: Asymptomatic stage IV intravascular leiomyomatosis - A diagnostic difficulty. Vasc Med 2024; 29:223-224. [PMID: 38131154 DOI: 10.1177/1358863x231211330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Yin Jun Law
- Department of Vascular Surgery, Canberra Hospital, Garran, ACT, Australia
| | | | - Gert Frahm-Jensen
- Department of Vascular Surgery, Canberra Hospital, Garran, ACT, Australia
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2
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Li T, Yang K, Huang W, Chen F. Intravenous leiomyomatosis involved cor dextrum: A review of diagnosis and management with an illustrative case. Radiol Case Rep 2024; 19:503-508. [PMID: 38044903 PMCID: PMC10686894 DOI: 10.1016/j.radcr.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 12/05/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is a benign disease that originates in the uterus and is characterized by aggressive intravenous growth that can extend to the inferior vena cava and even involve the intracardiac cavity. This extension of the IVL into the right heart is known as intracardiac leiomyomatosis (ICL). The clinical incidence of this disease is extremely low, and the characteristics of atypical aggressive growth lead to diagnostic dilemmas. Thus, studies on this disease have profound clinical significance. Here, we report a case of intracardiac leiomyomatosis and review the relevant literature. A 46-year-old female patient presented with exertive chest tightness and shortness of breath with an onset of approximately half a month. The patient underwent uterine myomectomy in 2018 and recovered well after surgery. On preoperative echocardiography, a hypoechoic mass was detected in the right atrium, which was diagnosed as a leiomyoma. Cardiac magnetic resonance imaging (MRI) revealed a T2-weighted mixed high-signal mass with partial cystic changes that extended from the inferior vena cava into the right atrioventricular cavity, occupying most of the atrial cavity and was misdiagnosed as an atrial mucinous tumor. The patient underwent cardiac tumor resection, tricuspid valvuloplasty, and lower-extremity vascular exploration under general anesthesia with extracorporeal circulation. The final pathological diagnosis was ICL. This is an illustrative analysis of various aspects of the disease, including pathology, etiology, clinical symptoms, imaging diagnosis, and treatment modalities.
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Affiliation(s)
| | | | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dic, Haikou, Hainan, 570311, PR China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dic, Haikou, Hainan, 570311, PR China
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Xie T, Masroor M, Liu C, Lin S, Song J, Wang Z, Chen X. Resection of intracardiac leiomyoma originating from the inferior vena cava through a single median sternotomy incision using a silk suture snare technique: a case report. BMC Cardiovasc Disord 2023; 23:592. [PMID: 38036979 PMCID: PMC10691141 DOI: 10.1186/s12872-023-03630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Intracardiac leiomyoma is a rare benign right heart tumor that usually extends from the intravenous system. The patient often has a history of uterine leiomyoma. CASE PRESENTATION We report a 46-year-old female patient who presented to us with exertional dyspnea, chest tightness, and shortness of breath for two weeks and had a history of uterine leiomyoma resection. Echocardiography showed a pedunculated solid mass in the right heart with the pedicle attached to the inferior vena cava. The surgery was performed under cardiopulmonary bypass established through the femoral artery and vein with a probable diagnosis of leiomyoma. The tumor was removed by ingenious surgical technique: a snare made of silk suture in which the tumor's pedicle was trapped, and the tumor with its pedicle was carefully removed with the help of a scalpel along the silk suture. The histopathology report confirmed the diagnosis of intravenous leiomyoma. The postoperative course was uneventful and the patient was discharged a week later. CONCLUSION Intracardiac leiomyoma is a rare benign smooth muscle tumor. Surgery is the mainstay of treatment with different surgical approaches available. It is possible to completely remove cardiac leiomyomas through sternotomy without the need for an abdominal incision if the leiomyoma is originated in the inferior vena cava not far from the right atrium.
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Affiliation(s)
- Ting Xie
- Department of Cardiac Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Matiullah Masroor
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Road, Kabul, Afghanistan
| | - Cong Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shengxiong Lin
- Department of Cardiac Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Jing Song
- Department of Cardiac Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
- Department of Cardiothoracic Surgery, Ezhou Central Hospital, Ezhou, 436000, China
| | - Zhengping Wang
- Department of Radiology, Hainan Traditional Chinese Medicine Hospital, Hainan, Haikou, 570203, China.
| | - Xuan Chen
- International College of Nursing, Hainan Vocational University of Science and Technology, Haikou, 570216, China.
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Garratt JL, Naiqiso S, Hockley J, Mohan GRKA. Intravascular leiomyomatosis with extension to the inferior vena cava. BMJ Case Rep 2023; 16:e253436. [PMID: 37336624 PMCID: PMC10314502 DOI: 10.1136/bcr-2022-253436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Intravascular leiomyomatosis (IVL) is a rare benign smooth muscle neoplasm growing within the pelvic venous system, often with caval and intracardiac extension. It frequently coexists with uterine leiomyomas or occurs in women with a history of myomectomy or hysterectomy. IVL is often asymptomatic until intracardiac extension occurs, and carries a risk of sudden death, necessitating timely diagnosis and management. We present a case of IVL diagnosed on hysterectomy specimen with extension to the inferior vena cava found on follow-up imaging. The patient underwent complete resection with multidisciplinary involvement of Gynaecological Oncology and Vascular Surgery and remains disease free following 12 months of follow-up.
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Affiliation(s)
- Jayna-Lee Garratt
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
| | - Silipa Naiqiso
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
| | - Joe Hockley
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Ganendra Raj Kader Ali Mohan
- King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
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Robotic-assisted laparoscopic and thoracoscopic approach: a challenging multidisciplinary minimally invasive surgery of intravascular leiomyomatosis with intracardiac extension. Fertil Steril 2023; 119:155-157. [PMID: 36400596 DOI: 10.1016/j.fertnstert.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To show a case of severe intravascular leiomyomatosis with intracardiac extension treated by a multidisciplinary minimally invasive surgery. DESIGN Stepwise demonstration of the technique with a video. SETTING General Hospital. PATIENT(S) A 40-year-old woman with palpitation and dyspnea. INTERVENTION(S) The patient was diagnosed with intravascular leiomyomatosis by computed tomography scan. She underwent a successful single-stage minimally invasive surgery with complete excision. MAIN OUTCOME MEASURE(S) The feasibility and safety of using this technique for intravascular leiomyomatosis with intracardiac extension. RESULT(S) A combined thoracoabdominal surgery was successfully performed. During the procedure, cardiopulmonary bypass was maintained for 72 minutes. The patient soon recovered and was discharged. CONCLUSION(S) Minimally invasive surgery is a possible choice for intravascular leiomyomatosis with intracardiac extension.
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Lim WH, Lamaro VP, Sivagnanam V. Manifestation and management of intravenous leiomyomatosis: A systematic review of the literature. Surg Oncol 2022; 45:101879. [DOI: 10.1016/j.suronc.2022.101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/19/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022]
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Cowie P, Eastwood B, Smyth S, Soleymani Majd H. Atypical presentation of intravascular leiomyomatosis mimicking advanced uterine sarcoma: modified laterally extended endopelvic resection with preservation of pelvic neural structures. BMJ Case Rep 2021; 14:e244774. [PMID: 34531237 PMCID: PMC8449947 DOI: 10.1136/bcr-2021-244774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/03/2022] Open
Abstract
Intravascular leiomyomatosis is a rare, benign tumour of myometrial smooth muscle. Despite being non-invasive, these tumours can proliferate aggressively within vascular structures including pelvic vessels, the vena cava and the heart. We discuss a 77-year-old woman presenting with a 9 cm uterine mass extending into the right adnexa and ovarian vein. Following hysteroscopic biopsy, palliative radical surgical resection was performed for suspected stage IV leiomyosarcoma. Tumour extension into the pelvic sidewall and obturator fossa indicated a modified laterally extended endopelvic resection combined with skeletonisation and preservation of the pelvic neurovasculature, ultimately providing a curative procedure with minimal functional neurological morbidity. We present this unusual case to assist in the development of a consensus for optimal case management where formal guidelines are not yet available. We summarise current understanding of intravascular leiomyomatosis and highlight the value of advanced surgical techniques using knowledge of complex ontogenetic and pelvic neuroanatomy in its management.
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Affiliation(s)
- Philip Cowie
- Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ben Eastwood
- Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Smyth
- Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hooman Soleymani Majd
- Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Schultz KL, Quinn SM, Miller AH, Fieman RE, Cipolle MD, Misselbeck TS, Roth KR. Point of care ultrasound facilitated diagnosis of right ventricular mass as the etiology of syncope; A case report of intravenous leiomyomatosis. Radiol Case Rep 2021; 16:1288-1293. [PMID: 33854666 PMCID: PMC8026911 DOI: 10.1016/j.radcr.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Syncope is a common emergency department (ED) chief complaint. Rarely, syncope can be the result of right ventricular outflow obstruction from an intracardiac tumor, such as an intracardiac extension of intravenous leiomyomatosis (IVL). Typically, this type of tumor is confined to the pelvic veins, but in very rare cases, it can extend through the inferior vena cava into the right atrium. Point-of-care ultrasound (POCUS) can be a crucial tool in the ED for identifying intracardiac tumors presenting as syncope and expediting clinical management. We present the case of a 39-year-old female with no prior medical history that presented to the ED having experienced dyspnea on exertion and two syncopal episodes prior to ED admission. POCUS use in the ED elucidated the presence of a right atrial mass and further imaging showed a mass on the patient's uterus. After surgical removal of a portion of the atrial mass, a subsequent biopsy revealed it had leiomyoma-like features; as such, the patient was diagnosed with IVL. This case illustrates the importance of using POCUS in the ED to help determine the etiology of syncope. Although intracardiac extensions of IVL are rare, it is important for emergency physicians to keep this diagnosis in the differential in patients with symptoms or risk factors suggestive of IVL with intracardiac extension.
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Affiliation(s)
- Kristine L Schultz
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Shawn M Quinn
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Andrew H Miller
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Rachel E Fieman
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Mark D Cipolle
- Department of Surgery, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Timothy S Misselbeck
- Department of Surgery, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Kevin R Roth
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
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9
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Deng Y, Song B. Three Case Reports of Intravenous Leiomyomatosis with Intracardiac Extensions. Thorac Cardiovasc Surg Rep 2020; 9:e40-e43. [PMID: 32963931 PMCID: PMC7500974 DOI: 10.1055/s-0040-1715183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background
Intravenous leiomyomatosis is a rare disease. Histologically, intravenous leiomyomatosis is a benign tumor, but its biological behavior can be malignant. The development of intracardiac extensions leads to congestive heart failure and occasionally sudden fatalities.
Case Description
The cases of three patients treated at our university between 2017 and 2018 were studied retrospectively. Intravenous tumors extending into the right heart system were fully removed without perioperative complications or death. Only one tumor recurrence was observed during the followed-up period.
Conclusion
The gold standard for the treatment of intravenous leiomyomatosis with intracardiac extension is complete and successful surgical resection.
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Affiliation(s)
- Yundan Deng
- Department of Cardiovascular Surgery, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Bing Song
- Department of Cardiovascular Surgery, Lanzhou University First Affiliated Hospital, Lanzhou, China
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10
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Lee E, LaBounty T, Romano M, Agarwal PP. Case of the Season: Intravenous Leiomyomatosis: a Rare Cause of Intracardiac Mass. Semin Roentgenol 2020; 55:226-229. [PMID: 32859339 DOI: 10.1053/j.ro.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Lee
- Department of Radiology, University of Michigan, Ann Arbor, MI.
| | - Troy LaBounty
- Department of Internal Medicine-Cardiology, University of Michigan, UMH Cardiovascular, Ann Arbor, MI
| | - Matthew Romano
- Department of Surgery-Cardiac Surgery, University of Michigan, Ann Arbor, MI
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11
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Wang W, Wang Y, Chen F, Zhang M, Jia R, Liu X, Zhang C, Shao J, Cheng N, Ma G, Zhu Z, Miao Q, Liang Z. Intravenous leiomyomatosis is inclined to a solid entity different from uterine leiomyoma based on RNA-seq analysis with RT-qPCR validation. Cancer Med 2020; 9:4581-4592. [PMID: 32372565 PMCID: PMC7333852 DOI: 10.1002/cam4.3098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Intravenous leiomyomatosis (IVL) is currently regarded as a special variant of the common uterine leiomyoma (LM). Though IVL shows a similar histological morphology to LM, IVL is characterized by unique intravenous growth patterns and low‐grade malignant potential, which are quite different from LM. There are currently few studies underlying the molecular alterations of IVL, though this information is important for understanding the pathogenesis of the disease, and for identifying potential biomarkers. Method We carried out a high‐throughput whole transcriptome sequencing of tumor and normal tissue samples from five IVL patients and five LM patients and compared the differentially expressed genes (DEGs) between IVL and leiomyoma. We performed multiple different enrichment and target analyses, and the expression of selected DEGs was validated using RT‐qPCR in formalin‐fixed samples. Results Our study identified substantial different genes and pathways between IVL and LM, and functional enrichment analyses found several important pathways, such as angiogenesis and antiapoptosis pathways, as well as important related genes, including SH2D2A, VASH2, ADAM8, GATA2, TNF, and the lncRNA GATA6‐AS1, as being significantly different between IVL and LM (P = .0024, P = .0195, P = .0212, P = .0435, P = .0401, and P = .0246, respectively). CXCL8, LIF, CDKN2A, BCL2A1, COL2A1, IGF1, and HMGA2 were also differently expressed between IVL and LM groups, but showed no statistical difference (P = .2409, P = .1773, P = .0596, P = .2737, P = .1553, P = .1045, and P = .1847, respectively) due to the large differences among individuals. Furthermore, RT‐qPCR results for five selected DEGs in IVL tissues and adjacent nontumor tissues were mainly consistent with our sequencing results. Conclusion Our results indicated that IVL may be a solid entity that is unique and different from LM, proving consistent with previous studies. Furthermore, we identified DEGs, particularly within angiogenesis and antiapoptosis pathway‐related genes that may play crucial roles in the development and pathogenesis of IVL and may be potential specific biomarkers.
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Affiliation(s)
- Wenze Wang
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Yanfeng Wang
- Department of Pathology, Heilongjiang Province Land Reclamation Headquarter General Hospital, Harbin, China
| | - Fei Chen
- Department of Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Ming Zhang
- Department of Pathology, Haidian Maternal & Children Health Hospital, Beijing, China
| | - Rujing Jia
- Accreditation Dept Five (Proficiency Testing Dept.), China National Accreditation Service for Conformity Assessment (CNAS), Beijing, China
| | - Xingrong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Ninghai Cheng
- Department of Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Zhiyong Liang
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Findakly D, Wang J. Molecular Profiling of Benign Metastasizing Leiomyoma of the Uterus Revealing Unique Novel Therapeutic Targets. Cureus 2020; 12:e7701. [PMID: 32431980 PMCID: PMC7233500 DOI: 10.7759/cureus.7701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Extra-uterine manifestations of benign uterine leiomyoma (fibroids) are rare. Benign metastasizing leiomyoma (BML) comprises an uncommon variant characterized by metastatic lung nodules. The pathologic characteristics for BML are well known in the literature; however, the underlying biology and molecular mechanisms remain poorly understood. We present a case of a 43-year-old woman who presented to the hospital complaining of dyspnea and lower extremity edema. Medical history includes a previous hysterectomy for leiomyomata two years prior. A reduced ejection fraction and right atrium globular filling defect are seen on transthoracic echo (TTE). CT scans of the chest, abdomen, and pelvis reported pelvic mass with an extensive inferior vena cava (IVC) thrombus extending into the right atrium, which was subsequently completely resected. Subsequent histopathology for the thrombus reported intravascular leiomyomatosis (IVL) and pelvic mass reported benign leiomyoma. Two years later, the symptoms recurred, and a chest CT revealed new pulmonary nodules. Subsequent pathology from a biopsy of these nodules was consistent with BML with ER+/PR+ on immunohistochemical staining. Genetic testing showed amplification of JUN, cyclin-dependent kinase 4 (CDK4), and MCL1, and loss of SUFU, AT-rich interaction domain 1A (AR1D1A), RB transcriptional corepressor 1 (RB1), and hepatocyte nuclear factor 1-alpha (HNF1A). The patient deemed to be a poor surgical candidate, and, therefore, she was started on hormonal treatment with leuprolide and letrozole. The disease remained stable upon follow-up at 48 months. Here, we report novel genomic profiling findings for the first time in a patient with a newly diagnosed BML. These findings may suggest molecular evidence that IVL may not be as benign as previously thought. Our study further highlights the value of genetic profiling in the understanding of this tumor's behavior and identification of new patient-specific therapeutic targets.
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Affiliation(s)
- Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Jue Wang
- Genitourinary Oncology, Creighton University School of Medicine/University of Arizona Cancer Center at Dignity Health St. Joseph's, Phoenix, USA
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13
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Thannickal A, Shafa A, Maharaj J, Schoolmeester JK, Heimbach J, DeMartino R, Bakkum-Gamez JN. Multidisciplinary management of extensive intravenous leiomyomatosis: A coordinated effort of a single institution. Gynecol Oncol Rep 2020; 32:100557. [PMID: 32258330 PMCID: PMC7114892 DOI: 10.1016/j.gore.2020.100557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Aneesa Thannickal
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, United States
| | - Anousheh Shafa
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, United States
| | - Joy Maharaj
- Department of Obstetrics and Gynecology, Park Nicollet Health Partners, St. Paul, MN 55426, United States
| | | | - Julie Heimbach
- Division of Transplant Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Randall DeMartino
- Division of Vascular Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Jamie N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, United States
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14
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Brar R, Skervin A, El-Sakka K, Fish A, Lewis M. Successful operative treatment of uterine leiomyoma with extensive intravenous extension to the IVC, right heart, and pulmonary arteries. Acta Chir Belg 2019; 119:182-185. [PMID: 29338669 DOI: 10.1080/00015458.2018.1427839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Intravenous extension of benign uterine leiomyomata ('fibroids'), in the absence of discrete metastatic disease has rarely been reported. 'Fibroids' remain one of the most common premenopausal uterine pathologies. METHODS AND RESULTS We report the diagnosis and multidisciplinary led operative management of a 52-year-old woman with a histologically benign, but biologically aggressive, uterine leiomyoma with intravenous extension to the inferior vena cava (IVC), right heart and pulmonary arteries. CONCLUSIONS Total abdominal hysterectomy and bilateral salpingo-oophorectomy combined with exploration of the sub-hepatic IVC and heart under deep hypothermic circulatory arrest achieved its successful macroscopic clearance.
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Affiliation(s)
- Ranjeet Brar
- Vascular and General Surgery, Croydon University Hospital, London, UK
| | | | - Karim El-Sakka
- Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - Andrew Fish
- Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
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15
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Shaukat I, Yassin S, Paudel A, Höti N, Mustafa S. Unusual presentation of parasitic leiomyoma; a tale of twists and turns. J Community Hosp Intern Med Perspect 2019; 9:168-170. [PMID: 31044051 PMCID: PMC6484481 DOI: 10.1080/20009666.2019.1591899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/01/2019] [Indexed: 01/01/2023] Open
Abstract
Uterine leiomyoma is the most common benign pelvic tumor of the myometrium, as the prevalence could be as high as 70%. Major risk factors include age between 40–60 years and African descent. It usually presents with abnormal uterine bleeding and/or pelvic pain or pressure. Extra-uterine cases of leiomyoma have been reported including Leiomyomatosis Peritonealis Disseminata (LPD), in which multiple nodules are found in the pelvis, peritoneum, or intestine. The term parasitic leiomyoma has been used in literature to describe a non-disseminating pattern . There is no clear explanation for pathogenesis; however, some reports linked it to previous uterine procedures. We are presenting here a case report of an unusual presentation of extra-uterine leiomyoma in a patient with a remote history of hysterectomy for uterine fibroids.
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Affiliation(s)
- Irfan Shaukat
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA
| | - Sayf Yassin
- Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Amrit Paudel
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Naseruddin Höti
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Urology, University of Texas Health Science CenterSan Antonio, San Antonio, TX, USA
| | - Sadaf Mustafa
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
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16
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Zhang X, Wu L, Xu R, Zhu C, Ma G, Zhang C, Liu X, Zhao H, Miao Q. Identification of the molecular relationship between intravenous leiomyomatosis and uterine myoma using RNA sequencing. Sci Rep 2019; 9:1442. [PMID: 30723247 PMCID: PMC6363745 DOI: 10.1038/s41598-018-37452-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to explore the potential relationship between intravenous leiomyomatosis (IVL) and uterine myoma (UM) at the molecular level. RNA-sequencing was performed on IVL tumours, UM tumours, and adjacent normal uterine muscle. We compared the gene expression levels between IVL and normal uterine muscle, UM and normal uterine muscle, to identify differentially expressed genes (DEGs). Then we used Gene Ontology Enrichment Analysis to determine the functions of the DEGs and performed specimen cluster analysis. We obtained 98 DEGs between IVL and adjacent normal uterine muscle, and 61 DEGs between UM and adjacent normal uterine muscle. Functional enrichment of both IVL and UM DEGs showed that they are associated with hormone stimulus, extracellular matrix, and cell adhesion. Unsupervised clustering analysis showed that IVL and UM could not be separated completely. Among these dysregulated genes, we found that HOXA13 showed a distinct dysregulated status between IVL and UM. HOXA13 may therefore serves as a biomarker to distinguish IVL and UM. Our results showed that IVL and UM may have similar dysregulated gene networks. They may be closely related, and HOXA13 may serves as a biomarker to distinguish between IVL and UM.
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Affiliation(s)
- Xu Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Liangcai Wu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Rongjian Xu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chengpei Zhu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Guotao Ma
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chaoji Zhang
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xingrong Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Haitao Zhao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Qi Miao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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17
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Aberrant uterine leiomyomas with extrauterine manifestation: intravenous leiomyomatosis and benign metastasizing leiomyomas. Obstet Gynecol Sci 2018; 61:509-519. [PMID: 30018906 PMCID: PMC6046354 DOI: 10.5468/ogs.2018.61.4.509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/17/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Intravenous leiomyomatosis (IVL) and benign metastasizing leiomyoma (BML) are uncommon variants of benign uterine leiomyomas with extrauterine manifestations. Categorizing the extent of disease allows clinicians to delineate the clinical spectrum and the level of sophistication for complete surgical resection. Methods Twelve patients with IVL and BML were reviewed. They were divided into early versus late stage disease groups, and initial manifestation, clinical characteristics, laboratory values, surgical pathology, and follow up data were summarized. Results Patients were mostly pre- or peri-menopausal and parous. Patients with late stage disease were more likely to present with cardiac symptoms or abnormal findings on chest X-ray, whereas those with early stage disease presented with classical leiomyoma symptoms including heavy menstrual bleeding, increased myoma size, or lower abdominal discomfort. Tumor marker levels were within normal ranges. A trend of higher neutrophil to leukocyte ratio was observed in the late versus the early stage group (10.4 vs. 1.51, P=0.07); the platelet leukocyte ratio was statistically higher in patients with late stage IVL (0.23 vs. 0.13, P=0.04). The overall recurrence rate was 25%. No recurrence was observed in stage I or stage III IVL groups, while 50% of the stage II IVL group showed recurrence in the pelvic cavity. Conclusion IVL and BML are benign myoma variants with paradoxically metastatic clinical presentation. Careful inquiry of systemic symptoms, the presence of underlying systemic inflammation, and a high index of suspicion are required for preoperative diagnosis. Furthermore, a multidisciplinary approach is necessary to improve outcomes of surgical resection.
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18
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Xu J, Wei M, Miao Q, Zhu B, Yu C, Huang Y. Perioperative management of intracardiac leiomyomatosis: An observational cohort study. Medicine (Baltimore) 2017; 96:e7522. [PMID: 28723765 PMCID: PMC5521905 DOI: 10.1097/md.0000000000007522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear.We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016.The mean patient age was 44.5 (range 25-55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived.Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible.
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Affiliation(s)
| | - Min Wei
- Department of Anesthesiology
| | - Qi Miao
- Department of Cardiac Surgery, Chinese Academy of Medical Sciences/Peking Union Medical College Hospital
| | - Bin Zhu
- Department of Anesthesiology, Peking University International Hospital, Beijing, P.R. China
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19
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Skripochnik E, Terrana LM, Labropoulos N, Henretta M, Griffin T, Loh SA. Inguinal pain and fullness due to an intravascular leiomyoma in the external iliac vein. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 3:102-104. [PMID: 29349391 PMCID: PMC5757769 DOI: 10.1016/j.jvscit.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/25/2017] [Indexed: 11/26/2022]
Abstract
Intravascular leiomyomatosis (IVL) is a benign smooth muscle tumor that evolves from the pelvic veins and can spread to the central veins and heart. Cardiac involvement is the most commonly reported presentation. Initial diagnosis is difficult, and IVL is commonly misdiagnosed as thrombus or atrial myxoma. Appropriate imaging and a high clinical suspicion are required for accurate diagnosis. We report a rare case of IVL in the external iliac vein that recurred 4 years after hysterectomy. Only four cases have been reported in the literature to involve the external iliac vein as it has no direct connection to pelvic venous drainage.
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Affiliation(s)
- Edvard Skripochnik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center T19-090, Stony Brook Medicine, Stony Brook, NY
| | - Lisa Marie Terrana
- Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center T19-090, Stony Brook Medicine, Stony Brook, NY
| | - Nicos Labropoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center T19-090, Stony Brook Medicine, Stony Brook, NY
| | - Melissa Henretta
- Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center T19-090, Stony Brook Medicine, Stony Brook, NY
| | - Todd Griffin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center T19-090, Stony Brook Medicine, Stony Brook, NY
| | - Shang A Loh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center T19-090, Stony Brook Medicine, Stony Brook, NY
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20
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Fang H, You Y, Cai F, Yang Y, Yang C, Lv P. Intravenous leiomyomatosis of the subclavian vein. J Vasc Surg Venous Lymphat Disord 2017; 5:254-256. [DOI: 10.1016/j.jvsv.2016.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
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21
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Wang J, Cheng Y, Lee YZ, Wang Y, Zheng Y, Dong R, Lai Y, Tang X, Yang Y, Wang S, He N, Jia Y, Cheng W, Liu D, Wang X, Zhang C. Sonography and Transthoracic Echocardiography for Diagnosis of Systemic Cardiovascular Metastatic Tumor Thrombi. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1993-2027. [PMID: 27492390 DOI: 10.7863/ultra.15.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
Sonography and transthoracic echocardiography (TTE) are seldom used for assessment of metastatic tumor thrombi in the cardiovascular system in routine clinical practice. We performed this retrospective study to evaluate the combination of sonography with TTE for diagnosis of metastatic tumor thrombi in heart and systemic vessels. Vascular, abdominal, pelvic, and small-part sonography was applied in 18 patients, and TTE was conducted simultaneously in 14 patients. Tumor thrombi invaded into the inferior vena cava system in 12 patients, superior vena cava system in 5 patients, and aorta in 1 patient; they extended to the right cardiac chambers in 11 patients. Six patients had diagnoses by pathologic examination. The primary neoplasms were identified by conventional imaging in 17 patients. The morphologic and echogenic characteristics of the tumor thrombi were diverse and depended on their original tumors. The thrombi were either contiguous or discrete from the original tumors. The neoplastic vascularity of the thrombi and the invasive extension were the primary characteristics that distinguished them from bland thrombi. Simultaneous application of sonography and TTE is a feasible way to comprehensively evaluate cardiovascular metastatic tumor thrombi in most patients.
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Affiliation(s)
- Jiong Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA, Department of Medical Ultrasonography, Peking University International Hospital, Beijing, China
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA
| | - Yongmei Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ye Zheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yongqiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaobin Tang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yaoguo Yang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Sheng Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Nan He
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yunfeng Jia
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Cheng
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Dan Liu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaona Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chun Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Abstract
Benign metastasizing leiomyoma (BML) is a rare and poorly characterized disease affecting primarily premenopausal women. Asymptomatic patients are often diagnosed incidentally by radiographs or other lung-imaging procedures performed for other indications, and the diagnosis is eventually confirmed by biopsy. Patients with BML are usually treated pharmacologically with antiestrogen therapies or surgically with oophorectomy or hysterectomy. Antiestrogen therapy is typically efficacious and, in general, most patients have a favorable prognosis. Asymptomatic patients with a confirmed diagnosis of BML, may be followed conservatively without treatment.
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Affiliation(s)
- Gustavo Pacheco-Rodriguez
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 5N307, 9000 Rockville Pike, Bethesda, MD 20892-1434, USA
| | - Angelo M Taveira-DaSilva
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D05, MSC-1590, 9000 Rockville Pike, Bethesda, MD 20892-1590, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D05, MSC-1590, 9000 Rockville Pike, Bethesda, MD 20892-1590, USA.
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23
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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.
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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.
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Kaur S, Tongaonkar HB, Maheshwari A, Menon S. A rare case of recurrent intravenous leiomyomatosis: Role of GnRH analogues? Indian J Cancer 2016; 52:161. [PMID: 26838010 DOI: 10.4103/0019-509x.175577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Kaur
- Department of Gynecological Oncology, Dharamshila Cancer Hospital, Delhi, India
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25
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Li R, Shen Y, Sun Y, Zhang C, Yang Y, Yang J, Su R, Jiang B. Intravenous leiomyomatosis with intracardiac extension: echocardiographic study and literature review. Tex Heart Inst J 2014; 41:502-6. [PMID: 25425982 DOI: 10.14503/thij-13-3533] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Uterine leiomyomatosis is a common disease in women; however, intravenous leiomyomatosis with intracaval and intracardiac tumor extension is rare. We sought to analyze the clinical and echocardiographic features of intracardiac leiomyomatosis. From January 2003 through July 2012, 7 women (age range, 24-59 yr) underwent surgical resection of histopathologically diagnosed intracardiac leiomyomas at our hospital. Most of the patients had histories of hysterectomy or uterine leiomyoma. We retrospectively analyzed their preoperative echocardiograms. We found that the tumors had no stalks, did not adhere to the wall of the right side of the heart, were highly mobile, and moved back and forth in the right atrium near the tricuspid orifice. All tumors originated from the inferior vena cava and had borders well demarcated from that structure's wall. Most of the masses extended into the inferior vena cava and right atrium through the right internal and common iliac veins. Computed tomograms revealed pelvic tumors and contiguous filling defects in 6 patients. When echocardiograms reveal a right-sided cardiac mass that originates from the inferior vena cava, particularly in women who have a history of hysterectomy or uterine leiomyoma, intracardiac leiomyomatosis should be suspected. If the mass has no stalk and freely moves within the inferior vena cava and right-sided cardiac chambers without attachment to the endothelial surface or endocardium, intracardiac leiomyomatosis should be diagnosed. We discuss our findings and briefly review the relevant medical literature.
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26
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Rovas L, Dauksas R, Simavicius A. Leiomyoma of the umbilical cord artery: A case report. World J Obstet Gynecol 2014; 3:138-140. [DOI: 10.5317/wjog.v3.i3.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/08/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
A leiomyoma is a benign tumor originating from non-striated muscle that is typically found in the uterus. Intravenous leiomyomatosis is a rare form found within the veins, usually associated with uterine fibroids, and tends to recur. These masses can spread from the uterus throughout the venous system. A rare case involving a subendothelial leiomyoma found in an umbilical cord artery is presented in this article. A 21-year-old patient presented with symptoms of preterm labor, which resulted in the premature birth of a female below the 10th percentile for 24-wk gestational age. The newborn died three days later, and microscopic analysis of the umbilical cord revealed occlusion of the artery by nodular structures. The antepartum diagnosis of intravascular leiomyoma was identified by immunohistochemistry showing that approximately 70% of all tumor cells were diffusely positive for smooth muscle markers, including desmin and smooth muscle actin. These findings indicate the possibility of a pathologic association between the umbilical cord leiomyoma, restriction of fetal growth and preterm delivery due to impaired circulation of blood in the umbilical cord.
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27
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Gu X, He Y, Li Z, Chen J, Liu W, Zhang Y, Nixon JVI. Intracardiac leiomyomatosis: clinical findings and detailed echocardiographic features--a Chinese institutional experience. J Am Soc Echocardiogr 2014; 27:1011-6. [PMID: 24909789 DOI: 10.1016/j.echo.2014.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intravenous leiomyomatosis is a rare, benign, smooth muscle tumor originating in the uterus that may extend through the inferior vena cava into the heart. Intracardiac leiomyomatosis (ICL), present in 10% of patients with intravenous leiomyomatosis, may cause right heart failure, tricuspid valve obstruction, and pulmonary embolism. The imaging characteristics of ICL continue to be reported. The purposes of this study were to characterize the echocardiographic features of ICL and to correlate the clinical findings. METHODS Between 1999 and 2012, 12 female patients with suspected ICL underwent cardiac surgery and histologic confirmation of the tumor. The clinical data, echocardiographic findings, and histologic results were retrospectively reviewed. RESULTS The ages of the patients with ICL ranged from 40 to 59 years. Ten patients (83%) had undergone myomectomy or hysterectomy, one patient had a uterine fibroid, and one patient had endometriosis. Seven patients (58%) reported dyspnea and/or palpitations, and one patient had syncope; four patients were asymptomatic. Echocardiographic findings included six patients with homogenous right atrial masses, four patients with myxoma-like right atrial masses, and two patients with serpentine, convoluted right atrial masses. In nine patients, the right atrial masses were noted to cross the tricuspid valve. All masses extended from the inferior vena cava. No masses appeared to adhere to the right atrium, right ventricular or pulmonary arterial walls, or tricuspid valve. Tricuspid regurgitation was noted in all patients. No pulmonary emboli were present. CONCLUSIONS The echocardiographic features of the ICL tumors varied. Tricuspid regurgitation and tumors emerging from the inferior vena cava were seen in all patients. Cardiac symptoms, including dyspnea, palpitations, and syncope, occurred in 67% of patients; the remaining 33% were asymptomatic.
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Affiliation(s)
- Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Zhian Li
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jian Chen
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Wenxu Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - J V Ian Nixon
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
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Xia M, Liu J, Xiang X, Xu M, He M. Intravenous leiomyomatosis with intracardiac involvement. Arch Gynecol Obstet 2014; 290:595-9. [DOI: 10.1007/s00404-014-3278-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/28/2014] [Indexed: 11/24/2022]
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Successful one-stage extraction of an intracardiac and intravenous leiomyoma through the right atrium under transesophageal ultrasound monitoring. Can J Anaesth 2014; 61:446-51. [PMID: 24585232 DOI: 10.1007/s12630-014-0130-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/17/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Intravenous leiomyomatosis is a rare disorder characterized by benign smooth-muscle tumours, termed leiomyomas, which originate from uterine leiomyomas or pelvic veins. Tumours may extend into the right-sided heart chambers, termed intracardiac leiomyomatosis (ICLM), and may be potentially life-threatening due to mechanical interference with cardiac structures or pulmonary arteries. While surgical excision is the optimal therapy, incomplete retrieval of a tumour or fatal retroperitoneal hemorrhage may occur. We present a case where intraoperative transesophageal ultrasound (TEU) guided complete removal of an intracardiac leiomyoma in a single-stage surgery solely through the right atrium without vein injury. CLINICAL FEATURES A 46-yr-old female patient presented with a two-week history of exertional dyspnea, palpitations, and syncope. Preoperative imaging modalities revealed a continuous solid mass extending from the inferior vena cava (IVC) into the right atrium, and the patient subsequently underwent open heart surgery for tumour removal and definitive diagnosis. A systematic intraoperative TEU examination performed before resection showed that the serpentine tumour was free from any attachment to the IVC and the heart. Furthermore, the diameter of the intracardiac end of the tumour was wider than that of the IVC. Given these findings, the surgeons carefully drew the cord-like tumour out of the right atrium under close TEU monitoring without vein injury. Post-extraction TEU examination showed complete removal of the tumour. Microscopic examination of the specimen confirmed the diagnosis of intravenous leiomyomatosis. CONCLUSIONS For cases with ICLM, intraoperative TEU plays a significant role in helping to plan the surgical approach, monitor the movement of the tumour and the IVC during the extraction, and assess the completeness of tumour resection.
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30
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Leiomiomatose intravenosa: do útero ao coração. ANGIOLOGIA E CIRURGIA VASCULAR 2013. [DOI: 10.1016/s1646-706x(13)70014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Clay TD, Dimitriou J, McNally OM, Russell PA, Newcomb AE, Wilson AM. Intravenous leiomyomatosis with intracardiac extension - a review of diagnosis and management with an illustrative case. Surg Oncol 2013; 22:e44-52. [PMID: 23642379 DOI: 10.1016/j.suronc.2013.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/05/2013] [Accepted: 03/27/2013] [Indexed: 12/01/2022]
Abstract
Intravenous leiomyomatosis with intracardiac extension is an uncommon pathologic progression of uterine leiomyomata. It is a histologically benign condition, however due to interfence with right sided cardiac function patients may present with marked cardiovascular compromise and present a diagnostic dilemma to clinicians who are unfamiliar with this condition. Given the rarity of this condition, experience in individual institutions is usually limited to a few cases. We present an illustrative case and provide a review of the clinical presentation, preoperative assessment, operative approach, pathology and postoperative issues. The importance of a multidisciplinary approach to diagnosis and management is highlighted. Operative management aims to completely resect all tumour in the safest manner for the patient, most commonly via single or two stage operation. Where complete resection is achieved, recurrence appears to be a rare event.
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Affiliation(s)
- Timothy D Clay
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia.
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Hinojosa CA, Medina-Franco H, Orozco-Zepeda V, Martinez Mijangos O, Valdes KA, Aragon Han P. Infrarenal transcaval extraction of intracardiac leiomyomatosis. Ann Vasc Surg 2013; 27:238.e1-4. [PMID: 23380551 DOI: 10.1016/j.avsg.2012.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 10/04/2011] [Accepted: 10/04/2011] [Indexed: 10/27/2022]
Abstract
Intravascular leiomyomatosis is a rare, histologically benign disease, and can spread through the venous system to the right cavities of the heart. We report the case of a 39-year-old woman who presented with intravenous leiomyomatosis with extension to the right ventricle, causing heart failure. She underwent surgery successfully, undergoing a total resection of this tumor through the infrarenal cava and the hysterectomy in one surgical stage. Surgical technique considerations are discussed and the literature is reviewed.
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Affiliation(s)
- Carlos A Hinojosa
- Department of Vascular Surgery and Oncological Surgery, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein. Fertil Steril 2012; 98:1341-5.e1. [DOI: 10.1016/j.fertnstert.2012.07.1121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 07/14/2012] [Accepted: 07/16/2012] [Indexed: 11/18/2022]
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Mariyappa N, Manikyam UK, Krishnamurthy D, Preeti K, Agarwal Y, Prakar U. Intravenous leiomyomatosis. Niger J Surg 2012; 18:105-6. [PMID: 24027407 PMCID: PMC3762011 DOI: 10.4103/1117-6806.103122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leiomyomas are benign tumors arising from smooth muscle of the uterus. Intravenous leiomyomatosis is characterized by intraluminal growth of benign smooth muscle into either venous or lymphatic vessels outside the limits of myoma. It commonly extends into the pelvic veins and manifests as worm-like protrusions of tumor emanating from veins at the parametrial margins of hysterectomy specimen. The tumor can cause life-threatening symptoms if it involves inferior vena cava or right atrium. We report a case of intravenous leiomyomatosis of the uterus managed at our institution.
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Affiliation(s)
- Narayanaswamy Mariyappa
- Department of Obstetrics and Gynaecology, Sri Devaraj Urs Academy of Higher Education and Research Center, Tamaka, Kolar, Karnataka, India
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Smith CC, Gold MA, Wile G, Fadare O. Cotyledonoid Dissecting Leiomyoma of the Uterus. Int J Surg Pathol 2012; 20:330-41. [DOI: 10.1177/1066896912450315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cotyledonoid dissecting leiomyoma is a rare benign uterine tumor whose gross and radiological appearance may raise the possibility of a malignancy. The authors summarize herein the clinical, radiological, and pathological features of the 41 previously reported cases. The patients typically presented with menorrhagia or symptoms that were ultimately relatable to the presence of a pelvic mass. The median patient age was 46 years (range 23-73). The average tumor size was 15.4 cm (range 4-41); most were exophytic, multinodular, occasionally cystic masses with a congested, spleen or placenta-like color, protruding over the uterine serosa and, variably, the broad ligaments and adjacent organs. In most cases, the exophytic component was contiguous with the intramural dissecting leiomyomatous components. Histological features suggestive of malignancy, such as cytological atypia, necrosis, or increased mitotic activity were absent. Intravascular growth, as assessed histologically, was present in 20% of reported cases, and this finding is apparently devoid of clinical significance based on limited data. Reported information on radiological features is limited. However, these lesions are typically isointense to myometrium on T1-weighted MRI and are in general less heterogeneous on T2 and postcontrast-imaging than sarcomatous lesions. The tumor may display extension to but not frank invasion of surrounding organs. Ultrasound features are nonspecific. Follow-up information was available in 25 (61%) of 41 reported patients: none experienced a tumor recurrence or metastases during the follow-up period, which ranged from 1 month to 41 years. This affirms the benign nature of this tumor, its alarming gross appearance and growth patterns notwithstanding.
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Affiliation(s)
| | | | - Geoffrey Wile
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oluwole Fadare
- Vanderbilt University Medical Center, Nashville, TN, USA
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Guo X, Zhang C, Fang L, Guo L, Zhu W, Fang Q, Chen G, Miao Q, Sun J. Echocardiographic characteristics of intravenous leiomyomatosis with intracardiac extension: a single-institution experience. Echocardiography 2011; 28:934-40. [PMID: 21854425 DOI: 10.1111/j.1540-8175.2011.01472.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Intravenous leiomyomatosis (IVL) is a rare smooth-muscle proliferation arising from a uterine myoma and occasionally extending into cardiac chambers. METHODS AND RESULTS A series of 10 consecutive patients with histologically and surgically proven intracardiac IVL between 2000 and 2010 in our hospital were reviewed. The echocardiographic features of 10 cases with IVL and extensive spread into the right-sided cardiac chambers were described for the first time. All patients were female and the mean age was 42±7 years old. The first symptoms of six patients (60%) were exertional dyspnea and palpitation of cardiac origin. Echocardiography showed that all the tumors originated from the inferior vena cava (IVC) and located in cardiac right chambers (70% in right atrium alone, 30% in right ventricle and atrium). Eight masses (80%) were oval, whereas the others (20%) were serpentine, all with well-demarcated borders and most (70%) with heteroechogenic texture. Five tumors (50%) intermittently prolapsed into right ventricle through the tricuspid valve. Two patients with nodules adhering to the top of the tumors had pulmonary tumorous thromboembolism. CONCLUSION Echocardiography is a simple and important technique to diagnose IVL with intracardiac extension. This disease should be considered in a female patient presenting with an extensive mass from IVC with well-demarcated border in the right-sided cardiac chambers.
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Affiliation(s)
- Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Partial resection of intravenous leiomyomatosis with cardiac extension. Gen Thorac Cardiovasc Surg 2011; 59:38-41. [PMID: 21225399 DOI: 10.1007/s11748-010-0620-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 03/16/2010] [Indexed: 10/18/2022]
Abstract
Intravenous leiomyomatosis with cardiac extension is rare and may result in a fatal outcome. A 58-year-old woman with a surgical history of myoma uteri was admitted to our hospital for treatment of intravenous leiomyomatosis extending into the right atrium through the inferior vena cava. We partially resected the tumor inside the right atrium and the inferior vena cava via the right atrium using cardiopulmonary bypass. There is no progression of the residual tumor after 25 months of follow-up.
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Oehler MK, Scopacasa L, Brown M, Kumar G, Edwards J. Intravenous uterine leiomyomatosis extending into the right heart. Aust N Z J Obstet Gynaecol 2010; 51:92-4. [PMID: 21299517 DOI: 10.1111/j.1479-828x.2010.01249.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Martin K Oehler
- Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, South Australia.
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Rispoli P, Santovito D, Tallia C, Varetto G, Conforti M, Rinaldi M. A one-stage approach to the treatment of intravenous leiomyomatosis extending to the right heart. J Vasc Surg 2010; 52:212-5. [DOI: 10.1016/j.jvs.2010.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 01/28/2010] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
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