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Wang Q, Liu H, Feng W. Unraveling the challenges of intravenous leiomyomatosis: a retrospective analysis of 11 cases. Arch Gynecol Obstet 2024; 309:621-629. [PMID: 38085353 PMCID: PMC10808418 DOI: 10.1007/s00404-023-07308-x] [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: 07/28/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study provides a concise overview of diagnostic and treatment strategies for intravenous leiomyomatosis (IVL), a rare disease with nonspecific clinical manifestations, based on cases from a tertiary referral hospital in China. METHODS We retrospectively analyzed 11 premenopausal patients with confirmed IVL between 2018 and 2022. Clinical data from Ultrasound, Enhanced CT, and MRI were studied, along with surgical details, postoperative pathology, and follow-up information. RESULTS Premenopausal patients showed no disease-specific symptoms, with 90.9% having a history of gynecological or obstetric surgery, and 72.7% having prior uterine fibroids. Cardiac involvement was evident in two cases, with echocardiography detecting abnormal floating masses from the inferior vena cava. Pelvic ultrasound indicated leiomyoma in 90.9% of cases, with ≥ 50 mm size. Surgery was the primary treatment, and lesions above the internal iliac vein resulted in significantly higher intraoperative blood loss (median 1300 ml vs. 50 ml, p = 0.005) and longer hospital stays (median 10 days vs. 4 days, p = 0.026). Three patients with lesions above the inferior vena cava required combined surgery with cardiac specialists. Recurrence occurred in 2 out of 11 patients with incomplete lesion resection. CONCLUSIONS IVL mainly affects premenopausal women with uterine masses, primarily in the pelvic cavity (Stage I). Pelvic ultrasound aids early screening, while Enhanced CT or MR assists in diagnosing and assessing venous lesions. Complete resection is crucial to prevent recurrence. Lesions invading the internal iliac vein and above pose higher risks during surgery. A multidisciplinary team approach is essential for patients with lesions above the inferior vena cava, with simultaneous surgery as a potential treatment option.
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Affiliation(s)
- Qun Wang
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hua Liu
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Weiwei Feng
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
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Zhou X, Qi X, Zhao X, Yang F. Update on clinical characteristics and molecular insights for uterine intravenous leiomyomatosis (Review). Oncol Lett 2024; 27:31. [PMID: 38108079 PMCID: PMC10722539 DOI: 10.3892/ol.2023.14165] [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: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
Intravenous leiomyomatosis (IVL) is a rare benign disease, which typically develops along vascular vessels and extends to the inferior vena cava and right atrium of the heart. In the early stages of the disease, the clinical manifestations and the results of imaging examinations are not uniform among patients. Thus, a high rate of misdiagnosis and missed diagnosis is common. When the tumor extends along the venous system to the pelvic floor vein or through the inferior vena cava involving the right atrium of the heart or the pulmonary artery, severe symptoms occur, such as ascites, dyspnea, heart failure and even sudden mortality. Improving the understanding of IVL to identify and evaluate this disease in its early stages is important. Complete tumor resection remains the primary treatment option for IVL. The recurrence rate of the disease varies depending on multiple factors, such as type of surgical procedure performed. Therefore, long-term follow-up is necessary for patients with IVL. The review of recent findings on the molecular and clinicopathological characterization of IVL is important to understand the pathogenesis of IVL. In the present study, the clinical manifestations, pathogenesis, differential diagnosis, treatment and prognosis of IVL are summarized in order to provide a single source of insightful information on IVL.
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Affiliation(s)
- Xiaoting Zhou
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Fan Yang
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Ge Z, Wang Y, Wang Y, Li W, Yang X, Li J, Wang H. Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study. Front Oncol 2023; 13:1203591. [PMID: 37492474 PMCID: PMC10364609 DOI: 10.3389/fonc.2023.1203591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Intravenous leiomyomatosis (IVL) is a rare and aggressive tumor type that has the potential to extend into the inferior vena cava (IVC) and is susceptible to be misdiagnosed and neglected. Despite its clinical significance, there is a paucity of research that has focused on the specific manifestations of IVL on ultrasonography. Therefore, this study aims to systematically analyze the specific ultrasound features of IVL and augment its diagnostic accuracy. Materials and method Prospective inclusion was granted to patients admitted to our hospital between December 2016 and March 2021 for an IVC-occupying lesion. Multi-modal ultrasonography, encompassing gray-scale and color Doppler, was conducted. Lesions were categorized as IVL or non-IVL based on pathological or follow-up data. Two ultrasound sonographers with over 5 years of experience read and recorded ultrasound data for all lesions, which were subsequently comparatively analyzed to identify specific signs of IVL. Results A total of 284 patients diagnosed with IVC-occupying lesions were included in the study. The lesion types comprised of IVL (n=67, 23.6%), IVC thrombus (n=135, 47.5%), tumor thrombus of renal carcinoma involving the IVC (n=35, 12.4%), tumor thrombus of liver carcinoma involving the IVC (n=24, 8.5%), leiomyosarcoma of the IVC (n=14, 4.9%), and tumor thrombus of adrenocortical adenocarcinoma (n=9, 4.1%). The presence of "sieve hole" and "multi-track" signs was observed in 20 IVL lesions under the grey-scale modality, while both signs were absent in the non-IVL group (P<0.01). The study found no statistically significant differences in the presentation of "sieve hole" and "multi-track" signs under the grey-scale and color Doppler modalities in cases of intravascular lithotripsy (IVL) (P>0.05). Using these two signs as diagnostic criteria for IVL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), miss rate, misdiagnosis rate, and accuracy were determined to be 29.9%, 100%, 100%, 82.2%, 70.1%, 0, and 83.5%, respectively (AUC ROC=0.649; 95%CI: 0.537-0.761). Conclusion IVL exhibits distinct ultrasound presentations, including "sieve hole" and "multi-track" signs, which demonstrate high specificity and accuracy as diagnostic indicators. Furthermore, these signs are corroborated by pathological evidence and effectively distinguish IVL from other lesions occupying the IVC.
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Affiliation(s)
| | | | | | | | | | - Jianchu Li
- *Correspondence: Jianchu Li, ; Hongyan Wang,
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Zhanga Y, Wua X. Treatment of intravascular leiomyomatosis: cases report and literature review. J Vasc Surg Cases Innov Tech 2023; 9:101059. [PMID: 37152917 PMCID: PMC10160508 DOI: 10.1016/j.jvscit.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/25/2022] [Indexed: 02/17/2023] Open
Abstract
Intravascular leiomyomatosis is a rare disease characterized by the proliferation of a smooth muscle tumor in the vascular lumen and possible cardiac extension. The best surgical procedure is yet to be identified. The present study aimed to explore the optimal surgical strategies. Fourpatients with intravascular leiomyomatosis in our hospital were analyzed retrospectively. All patients underwent one-stage surgery with multidisciplinary collaboration and were followed for 2 to 56 months. Based on the preliminary results, we found that one-stage surgery is safe and effective. We recommended Ma's staging system as a guide for selecting the surgical procedures.
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Chen J, Bu H, Zhang Z, Chu R, Qi G, Zhao C, Wang Q, Ma X, Wu H, Dou Z, Wang X, Kong B. Clinical features and prognostic factors analysis of intravenous leiomyomatosis. Front Surg 2023; 9:1020004. [PMID: 36793517 PMCID: PMC9922872 DOI: 10.3389/fsurg.2022.1020004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023] Open
Abstract
Background The treatment and prognostic factors of intravenous leiomyomatosis (IVL) remain lacking systematic evidence. Methods A retrospective study was conducted on IVL patients from the Qilu Hospital of Shandong University, and IVL cases were published in PubMed, MEDLINE, Embase and Cochrane Library databases. Descriptive statistics were used for the basic characteristics of patients. The Cox proportional hazards regression analysis was used to assess the high-risk factors related to the progression-free survival (PFS). The comparison of survival curves was performed by Kaplan-Meier analysis. Results A total of 361 IVL patients were included in this study, 38 patients from Qilu Hospital of Shandong University, and 323 patients from the published literature. Age ≤45 years was observed in 173 (47.9%) patients. According to the clinical staging criteria, stage I/II was observed in 125 (34.6%) patients, and stage III/IV was observed in 221 (61.2%) patients. Dyspnea, orthopnea, and cough were observed in 108 (29.9%) patients. Completed tumor resection was observed in 216 (59.8%) patients, and uncompleted tumor resection was observed in 58 (16.1%) patients. Median follow-up period was 12 months (range 0-194 months), and 68 (18.8%) recurrences or deaths were identified. The adjusted multivariable Cox proportional hazard analysis showed age ≤45 years (vs. >45) (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.15-3.80, p = 0.016), and uncompleted tumor resection (vs. completed tumor resection) (HR = 22.03, 95% CI 8.31-58.36, p < 0.001) were high-risk factors related to the PFS. Conclusion Patients with IVL have a high probability of recurrence after surgery and a poor prognosis. Patients younger than 45 years and with uncompleted tumor resection are at higher risk of postoperative recurrence or death.
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Affiliation(s)
- Jingying Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaoyang Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Qiuman Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyue Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Huan Wu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiyuan Dou
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Xia Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Xia Wang Beihua Kong
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China,Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Xia Wang Beihua Kong
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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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Kikuchi DS, Goulbourne CA, Starbuck KD, Fernandes MF. Case report: intravenous leiomyomatosis with intracaval and intracardiac growth. Eur Heart J Case Rep 2022; 7:ytac464. [PMID: 36600803 PMCID: PMC9799196 DOI: 10.1093/ehjcr/ytac464] [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: 03/13/2022] [Revised: 08/02/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
Background Intravenous leiomyomatosis (IVL) is a rare, benign smooth muscle cell tumour that extends beyond the pelvis. These tumours grow within vascular channels and can progress to involve the heart and pulmonary vasculature. Case Summary A 44-year-old female initially presented to her primary care physician for subacute bloating. In the weeks leading up to her presentation, she was in good health. On admission, computed tomography (CT) imaging of the abdomen and pelvis was notable for a mixed solid and cystic mass arising from the fundal myometrium with invasion into the inferior vena cava (IVC). Transthoracic echocardiogram (TTE) was notable for mobile mass in the right atrium originating from the IVC. The mass was further evaluated by cardiac magnetic resonance (CMR) imaging before a multidisciplinary, single-staged thoracoabdominal resection was performed. The procedure was well tolerated, and the entire mass was successfully removed without complication. Subsequently, pathological analysis of the resected tumour revealed benign smooth muscle cells, confirming the diagnosis of IVL. Discussion Intravenous leiomyomatosis is a rare cause of right-sided cardiac tumours but should be considered in premenopausal females, even those with a prior history of hysterectomy. The clinical presentation of patients with IVL is varied and imaging including CMR, CT, and TTE to evaluate the tissue characteristics and source of the cardiac mass should be performed. Finally, while imaging revealing a freely mobile pelvic mass extending into the IVC and right heart chambers is strongly suggestive of IVL, definitive diagnosis requires pathological analysis of resected tissue.
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Affiliation(s)
| | - Clive A Goulbourne
- Division of Cardiology, Department of Medicine, Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322, USA
| | - Kristen D Starbuck
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322, USA
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Lan S, Wang X, Li Y, Zhai M. Intravenous leiomyomatosis: A case study and literature review. Radiol Case Rep 2022; 17:4203-4208. [PMID: 36105826 PMCID: PMC9464787 DOI: 10.1016/j.radcr.2022.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
The dissertation presents a case of intravenous leiomyomatosis and conducts the literature review. A 31-year-old woman with a hysteromyomectomy history presented with abnormal uterine bleeding and anemia, a large pelvic tumor, underwent excision of the uterine and bilateral salpingo-oophorectomy. A pathological diagnosis determined it as intravenous leiomyomatosis. The patient recovered well, and no recurrence was noted after 1 year of follow-up. Intravenous leiomyomatosis is rare. Imaging is helpful, but the final diagnosis of intravenous leiomyomatosis is usually made following surgical excision and histopathology. Early surgical resection is a better treatment modality.
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Affiliation(s)
- Suwei Lan
- Department of Gynecology, Affiliated Hospital of Chengde Medical University, Zhuanwayaopian Zone, Fengyingzi Town, Development zone, Chengde City, Hebei Province, China
| | - Xingcha Wang
- Department of Gynecology, Affiliated Hospital of Chengde Medical University, Zhuanwayaopian Zone, Fengyingzi Town, Development zone, Chengde City, Hebei Province, China
- Corresponding author.
| | - Yang Li
- Department of Pediatric, Chengde City Maternal and Child Health Care Hospital Institution, No.9, Guanfeng Road, Shuangqiao zone, Chengde City, Hebei Province, China
| | - Mingjing Zhai
- Department of Gynecology, Affiliated Hospital of Chengde Medical University, Zhuanwayaopian Zone, Fengyingzi Town, Development zone, Chengde City, Hebei Province, China
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Wang C, Shao J, Ma X, Zhou Y, Ma G, Cheng N, Cao D, Lai Z, Song X, Li K, Liu B. One-stage resection of intravascular leiomyomatosis involving the right heart chamber through a single laparotomy. Front Cardiovasc Med 2022; 9:976478. [PMID: 36324740 PMCID: PMC9618637 DOI: 10.3389/fcvm.2022.976478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/27/2022] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES This retrospective study aimed to summarize the feasibility and experience of utilizing a one-stage operation via single laparotomy to treat intracardiac leiomyomatosis (ICL). MATERIALS AND METHODS A retrospective study of 13 patients with ICL who underwent one-stage resections was conducted at Peking Union Medical College Hospital from June 2015 to December 2021. All patients had their tumors removed by single laparotomy and were divided into a short venotomy group (6 cases) and an extensive venotomy group (7 cases). We reviewed the patient characteristics, surgical procedures, postoperative pathology, and perioperative and follow-up outcomes of all patients. RESULTS All patients underwent surgery for ICL resection using single laparotomy with a 100% success rate. Two patients had tumors distal to the right ventricle (RV), 2 patients had tumors that protruded into the RV in diastole and were confined to the right atrium (RA) in systole, and the other 9 patients had tumors confined to the RA that did not involve the tricuspid valve. The tumor was completely resected in 10 patients, yet 3 patients had a residual tumor. Six patients completed the surgery with short venotomy, 7 completed the surgery with extensive venotomy, and 9 underwent simultaneous total hysterectomy and bilateral adnexal resection. The mean operative time was 370.8 ± 111.0 min, and the mean blood loss was 992.3 ± 994.5 mL. Intraoperative blood loss was lower (483.3 ± 213.7 ml vs. 1429.2 ± 1208.0 ml; P = 0.020) and operative time was shorter (286.5 ± 71.9 min vs. 443.1 ± 84.4 min; P=0.004) in the short venotomy group than in the extensive venotomy group. At a mean follow-up of 26.3 ± 18.8 months, 1 patient had a local recurrence in the pelvis, and 1 patient died of pancreatic cancer, while the remaining patients had no recurrence during follow-up. CONCLUSION One-stage resection of ICL patients by means of a single laparotomy is feasible and effective.
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Affiliation(s)
- Chaonan Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Ma
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ninghai Cheng
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xitao Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Peng L, Wei W. Early recurrence of intravenous leiomyomatosis with intracardiac extension secondary to initial misdiagnosis: A case report. Asian J Surg 2022; 46:1637-1638. [PMID: 36253261 DOI: 10.1016/j.asjsur.2022.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/02/2022] Open
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Kan H, Cao Y, Chen Y, Zheng Y. Intravenous Leiomyomatosis Complicated by Arteriovenous Fistula: Case Series and Literature Review. Front Cardiovasc Med 2022; 9:878386. [PMID: 35770232 PMCID: PMC9234661 DOI: 10.3389/fcvm.2022.878386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUterine intravenous leiomyomatosis (IVL), a rare type of uterine leiomyoma, is defined by the intravascular proliferation of a histologically benign smooth muscle cell tumor. Pelvic arteriovenous fistula (AVF) is a rare vascular malformation that is most commonly congenital, post-traumatic, or iatrogenic. The link between leiomyomatosis and AVF has received little attention in the medical literature.ResultsWe provide a case series of seven patients, four of whom were from our center, who had IVL complicated by a pelvic AVF. The symptoms of right heart failure were noted as swelling in the abdomen and two legs as well as a significant amount of ascites. Coil embolization of AVFs may be beneficial in minimizing bleeding during IVL surgery. A review of all accessible literature published on IVLs from 2000 to 2020 was conducted, and data were retrieved from 78 papers totaling 262 cases. Complications and recurrence were associated with pelvic mass excision and intravascular remnant tumor, respectively.ConclusionIntravenous leiomyomatosis combined with AVF aggravates congestion symptoms of surrounding organs. It is worth noting the uncommon combination of AVF and IVL, stressing the importance of a thorough assessment and surgical approach in IVL treatment.
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Affiliation(s)
- Haoxuan Kan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Cao
- Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Yuexin Chen
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Yuexin Chen
| | - Yuehong Zheng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yuehong Zheng
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Shaked E, Sharoni R, West DG, Lev EI. Intravascular leiomyomatosis with cardiac extension: a case report. Eur Heart J Case Rep 2022; 6:ytac001. [PMID: 35174306 PMCID: PMC8846171 DOI: 10.1093/ehjcr/ytac001] [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: 05/15/2021] [Revised: 06/29/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Intravascular leiomyomatosis (IVL) with intracardiac extension is a rare benign tumour seen exclusively in women, characterized by proliferation of uterine smooth muscle cells through the venous circulation into the inferior vena cava (IVC) and the right heart chambers. CASE SUMMARY A 47 years old women with history of previous hysterectomy due to myomatosis, presented with nausea, anorexia, and bilateral lower limb swelling over the preceding 2 months. An outpatient abdominal ultrasound discovered a mass in the IVC. Echocardiogram and computed tomography demonstrated a large intravascular mass extending from the pelvis to the right heart chambers. The tumour was completely removed in a concomitant open-heart surgery and laparotomy. Post-operative course was uncomplicated. A month later, the patient was feeling well and in good clinical condition. The histological analysis consisted with IVL. DISCUSSION Intracardiac leiomyomatosis is a rare clinical condition which requires high index of suspicion. Multimodality imaging is usually required to establish the preoperative diagnosis, although the final diagnosis is achieved with tissue investigation. Complete surgical resection of the tumour is curative and associated with good long-term prognosis.
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Affiliation(s)
- Einat Shaked
- Cardiology Division, Assuta Ashdod University Hospital, Ben Gurion University of the Negev, 7 Harefu'a St, 7747629 Ashdod, Israel
| | - Ram Sharoni
- Department of Cardiothoracic Surgery, Rabin Medical Center, Tel Aviv University, 39 Jabotinsky St. 49100 Petah Tikva, Israel
| | - Debra Gershov West
- The Urgent Care Department, Assuta Ashdod University Hospital, Ben Gurion University of the Negev, 7 Harefu'a St, 7747629 Ashdod, Israel
| | - Eli I Lev
- Cardiology Division, Assuta Ashdod University Hospital, Ben Gurion University of the Negev, 7 Harefu'a St, 7747629 Ashdod, Israel
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Liang J, Lei R, Xie M, Lin S, Xu J, Ling X, Xie Q. The role of estrogen deprivation therapy in premenopausal women with primary unresectable intracardiac leiomyomatosis: a systematic review and meta-analysis. Orphanet J Rare Dis 2021; 16:453. [PMID: 34715881 PMCID: PMC8555203 DOI: 10.1186/s13023-021-02087-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intracardiac leiomyomatosis (ICLM) is a rare life-threatening form of intravenous leiomyomatosis (IVLM). The incomplete resection and recurrence are associated with high morbidity and mortality. The objective of this study is to identify that whether estrogen deprivation therapies, including bilateral salpingo-oophorectomy (BSO)-based surgery and gonadotrophin releasing hormone agonists (GnRHa) administration, could bring benefits to patients with primary unresectable ICLM. METHODS PubMed/MEDLINE (Ovid) was searched (up to May 2021) for studies reporting individual patient data on demographics, clinicopathological features, treatment, and follow-up information. Exclusion criteria were patients who may have been included in two or more publications. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 114 patients from 70 papers were included. Several reports showed that the tumor in the right atrium and inferior vena cava shrank dramatically after BSO-based surgery, or GnRHa administrated preoperatively in premenopausal women. The rate of complete resection was 64.04% in patients with ICLM, which was 85.25% in no/slight adhesion and no pulmonary nodules group, while 22.22% in firm/extensive adhesion and/or pulmonary nodules group (p < 0.0001). Meanwhile, the recurrence rates in patients with complete resection and incomplete resection were 4.29% and 37.84% respectively (p < 0.0001). Furthermore, complete resection with BSO had the lowest recurrence rate of 3.13%, incomplete resection with BSO had a progression rate of 45.45%, while incomplete resection with ovarian preservation had the highest progression rate of 75.00%. CONCLUSIONS The recurrence rate of ICLM was closely related to firm/extensive adhesion in IVC or above, and/or pulmonary nodules. BSO-based surgery might reduce the recurrence rate no matter ICLM could be completely resected or not. In addition, estrogen deprivation therapies could decrease tumor burden as a primary treatment, and further make a secondary complete resection feasible in premenopausal women with initially unresectable ICLM.
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Affiliation(s)
- Jinxiao Liang
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Ruilin Lei
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Mingwei Xie
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Shaodan Lin
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Jing Xu
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China
| | - Xiaoting Ling
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China.
| | - Qingsheng Xie
- Department of Gynecological Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Rd West, Guangzhou, 510120, People's Republic of China.
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Chen YL, Zheng A, Han L. Intravascular leiomyomatosis with intracardiac extension: A case report. Asian J Surg 2021; 45:500-501. [PMID: 34629273 DOI: 10.1016/j.asjsur.2021.09.002] [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: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Intravascular leiomyomatosis (IVL) is a rare disease, especially with intracardiac extension. Early diagnosis and treatment are essential for IVL with intracardiac involvement because it can result in significant morbidity and mortality. CASE REPORT We present a case of IVL with intracardiac extension, which was treated with one-stage surgery by a multidisciplinary surgical team. The patient recovered adequately and had no recurrence for 12 months after surgery. CONCLUSION A one-stage surgical approach can be used to remove an IVL completely and is a good treatment option when the patien's condition is favorable.
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Affiliation(s)
- Ya-Li Chen
- Department of Gynaecology and Obstetrics,West China Second Hospital,Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ai Zheng
- Department of Gynaecology and Obstetrics,West China Second Hospital,Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Ling Han
- Department of Gynaecology and Obstetrics,West China Second Hospital,Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, 610041, China.
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15
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Mathey MP, Duc C, Huber D. Intravenous leiomyomatosis: Case series and review of the literature. Int J Surg Case Rep 2021; 85:106257. [PMID: 34343794 PMCID: PMC8350006 DOI: 10.1016/j.ijscr.2021.106257] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/17/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Intravenous leiomyomatosis (ILV) is a rare pathology, part of leiomyoma beyond the uterus (LBU), characterized by benign smooth muscle cell tumor outside of the uterus and mainly affecting premenopausal woman with a medical history of leiomyoma or gynecologic surgical treatment. The treatment depends on the localization of the tumor, age of the patient, initial size, symptoms and the suitability for surgery but should always aims in toto surgical resection. Case presentation Retrospective case series and review of literature. Clinical discussion Symptoms presented by the patient were aspecific and only localized in the pelvic area. All cases were fortuitous histopathological diagnosis. No relapse was. Two out of 5 patients have pulmonary nodules, only one was biopsied and diagnosed with PBML (pulmonary benign metastasizing leiomyoma). Conclusion IVL and BML are rare disease that can co-exist. Because of tumoral hormonal receptors, hormonotherapy could be an optional treatment but to date no clear efficacy is demonstrated. In case of high recurrence risk such as voluminous initial mass, impairment of broad ligament, failure of total surgical resection, adjuvant hormonotherapy could be useful. Recurrence rate is about 16.6-30% and can occur even dozen years later and even after radical surgery, justifying a regular follow up. Leiomyomas beyond the uterus (LBU) is defined by benign smooth muscle cell tumor outside of the uterus. Sub classification of this entity are intravenous leiomyomatosis (IVL), benign metastasizing leiomyomas (BML), diffuse peritoneal leiomyomatosis (DPL), retroperitoneal leiomyomas and parasitic leiomyomas. The differential diagnosis of IVL should include benign myoma, thrombus, leiomyosarcoma, soft tissue sarcoma, lymphoma, cardiac myxoma, tumor thrombosis of Wilms tumor or metastasis. Treatment of IVL is usually surgery but there is no consensus about the the optimal approach. Adjuvant therapy sur as bilateral salpingoophorectomy followed by hormonothetherapy have to be balanced with their side effects. Despite being histologically benign, BML shows the metastatic potential of LBU. Because of a high rate of recurrence estimated of 16.6% to 30%, long term follow up is recommended even after radical surgery.
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Affiliation(s)
- M P Mathey
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - C Duc
- Department of Pathology, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland
| | - D Huber
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland; Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
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16
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Ge Z, Feng P, Zhang Z, Li J, Yu Q. Identification of Novel Serum Metabolic Biomarkers as Indicators in the Progression of Intravenous Leiomyomatosis: A High Performance Liquid Chromatography-Tandem Mass Spectrometry-Based Study. Front Cell Dev Biol 2021; 9:695540. [PMID: 34307370 PMCID: PMC8297591 DOI: 10.3389/fcell.2021.695540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Intravenous leiomyomatosis (IVL) is a rare estrogen-dependent neoplasm. However, identifiable and reliable biomarkers are still not available for clinical application, especially for the diagnosis and prognosis of the disease. Methods In the present study, 30 patients with IVL and 30 healthy controls were recruited. Serum samples were isolated from these participants for further high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) analysis to study metabolomics alterations and identify differentially expressed metabolites based on orthogonal partial least-squares discriminant analysis (OPLS-DA). Subsequently, lasso regression analysis and a generalized linear regression model were applied to screen out hub metabolites associated with the progression of IVL. Results First, 16 metabolites in the positive ion mode were determined from the 240 identifiable metabolites at the superclass level, with ten metabolites upregulated in the IVL group and the remaining six metabolites downregulated. Our data further proved that four metabolites [hypoxanthine, acetylcarnitine, glycerophosphocholine, and hydrocortisone (cortisol)] were closely related to the oncogenesis of IVL. Hypoxanthine and glycerophosphocholine might function as protective factors in the development of IVL (OR = 0.19 or 0.02, respectively). Nevertheless, acetylcarnitine and hydrocortisone (cortisol), especially the former, might serve as risk indicators for the disease to promote the development or recurrence of IVL (OR = 18.16 or 2.10, respectively). The predictive accuracy of these hub metabolites was further validated by the multi-class receiver operator characteristic curve analysis (ROC) with the Scikit-learn algorithms. Conclusion Four hub metabolites were finally determined via comprehensive bioinformatics analysis, and these substances could potentially serve as novel biomarkers in predicting the prognosis or progression of IVL.
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Affiliation(s)
- Zhitong Ge
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Penghui Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zijuan Zhang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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17
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Miro A, Coppola Bottazzi E, Vanella S, Palma T, Noviello A, Apicella I, Lombardi G, Fiorani B, Crafa F. Intravascular leiomyomatosis with intracardiac extension: a toraco-abdominal approach. J Surg Case Rep 2021; 2021:rjab249. [PMID: 34194725 PMCID: PMC8238396 DOI: 10.1093/jscr/rjab249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Intravenous leiomyomatosis is a rare nonmalignant tumor, which originates from the uterine smooth muscle cells and is usually confined to the pelvic venous system. Sometimes it can extend from the pelvis through the veins into the right side of the heart; this condition is named intracardiac leiomyomatosis (ICLM). To date few cases of these conditions have been described, the treatment is surgical, often challenging and usually multidisciplinary. In this paper are described the clinical presentation, the full radiologic study and surgical treatment of a case of ICLM that authors treated at their institution with thoraco-abdominal approach. Surgical removal of the ICLM is strongly recommended, because no recurrence has been reported, in our case at 7 years we did not observe recurrence of the disease.
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Affiliation(s)
- Antonio Miro
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Enrico Coppola Bottazzi
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Serafino Vanella
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Tommaso Palma
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Adele Noviello
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Ivano Apicella
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Giulio Lombardi
- Department of Radiology, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Brenno Fiorani
- Cardiac Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Francesco Crafa
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
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Abstract
The diagnosis of pulmonary embolism (PE) is often made more challenging by the presence of diseases that can mimic thromboembolic disease. There is no specific or sensitive constellation of clinical signs or symptoms that can be used to diagnose PE. Ventilation/perfusion scans can have false-positive findings related to mediastinal conditions that can compress the pulmonary arteries, and pulmonary hemorrhage can resemble PE on V/Q scanning with potentially devastating consequences if anticoagulation is started. CT-scan related issues l eading to potential false-positive diagnoses range from inadequate imaging technique, to systemic-pulmonary shunting, to non-thrombotic occlusion of pulmonary arteries by tumor, septic emboli, and emboli of fat, air, and foreign material, as well as vasculitic processes. Careful assessment of the patient and consideration of these potential mimickers is imperative to correct diagnosis of this potentially life-threatening condition.
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Affiliation(s)
- Yuri Matusov
- Cedars-Sinai Medical Center - Pulmonary & Critical Care Medicine, Los Angeles, California, United States
| | - Victor F Tapson
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Medical Center - Venous Thromboembolism and Pulmonary Vascular Disease Research Program, Los Angeles, California, United States
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19
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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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20
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Deng Y, Dong S, Song B. Surgical Strategy for Intravenous Cardiac Leiomyomatosis. Heart Lung Circ 2020; 30:240-246. [PMID: 32830033 DOI: 10.1016/j.hlc.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Intravenous-cardiac leiomyomatosis (IVCL) is a rare, histologically benign but biologically aggressive tumour. Accurate diagnosis and appropriate treatment choices are important for prognosis. The best surgical approach remains unclear owing to limited evidence. This study aimed to assess surgical strategies for treating IVCL and to propose individualised surgical strategies. We searched PubMed, Web of Science, and the Cochrane Library to identify case reports and case series published in English over the last 10 years. Two (2) reviewers independently screened the literature according to the inclusion and exclusion criteria, and subsequently extracted data. One hundred and ten (110) cases were included. According to our analysis, IV cardiac leiomyomatosis is most common in the fifth decade, and the mean age at detection is 45.71±7.67 years. Most patients had undergone previous hysterectomy/myomectomy, or had a co-existing uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, palpitation, pelvic mass, and leg oedema. More patients benefited more from one-stage surgery. Seventy-eight per cent (78%) of cases experienced a surgical approach of thoracic and abdominal incisions. Extractions of IVCL were varied. Eighty-seven (87) patients experienced cardiopulmonary bypass and deep hypothermic circulatory arrest was performed on 64.4% of them. Total hysterectomy and bilateral oophorectomy, together with pelvic leiomyoma excision, were done in 76.0% of patients. Overall, surgical strategies for IVCL are varied; the optimal strategy required consideration of multiple factors. Complete resection is recommended for both single- and two-stage operations. Once complete resection is achieved, recurrence is rare.
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Affiliation(s)
- Yundan Deng
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Shuai Dong
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Bing Song
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China.
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21
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Li H, Xu J, Lin Q, Zhang Y, Zhao Y, Tong H, Tu R, Xu D, Wang C, Lu W. Surgical treatment strategies for extra-pelvic intravenous leiomyomatosis. Orphanet J Rare Dis 2020; 15:153. [PMID: 32546179 PMCID: PMC7296750 DOI: 10.1186/s13023-020-01394-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extra-pelvic intravenous leiomyomatosis (IVL) extending into inferior vena cava (IVC) or heart (i.e. intracardiac leiomyomatosis, ICL) is an extremely rare benign disease. No consensus has been reached on the optimal surgical strategy. The aim of this study is to introduce four types of one-stage surgical strategies including less invasive options and a guideline to select patient-specific strategy for this disease. METHODS Twenty-four patients of extra-pelvic IVLs receiving one-stage resections at the Zhongshan Hospital from July 2011 to November 2019 were reviewed retrospectively. Base on the initial experiences of the indiscriminate choices of tumor thrombectomies through sterno-laparotomy under cardiopulmonary bypass (CPB) in 6 ICLs, an anatomy-based guideline for four types of surgical strategies was developed and applied for the next 18 patients. RESULTS Under the direction of guideline, tumor thrombectomies through single laparotomy were applied without CPB in 2 ICLs and 4 IVLs confined in IVC, or with CPB in 7 ICLs. Guideline-directed double-incisions with CPB were applied in only 5 ICLs, including 1 receiving mini-thoracotomy and 4 receiving sternotomy because of tumor adherences with right atriums in 2 and with pulmonary arteries in 2. All 24 patients accomplished one-stage panhysterectomy, bilateral adnexectomy and complete resections of intracaval and intracardiac tumors. For residual pelvic intravenous tumors in 19 patients, 17 received macroscopically complete resections while the other 2 failed because of high risk of hemorrhage. Intraoperative blood losses, operation time and hospitalization expense in the single-laparotomy non-CPB group were significantly lesser than the other groups. In CPB groups, inpatient stay and hospitalization expense in the single-incision group were significantly lesser than the double-incisions group. All patients were alive and free of recurrences during a mean follow-up of 35.4 ± 27.2 months (range, 1-100 months). The pelvic tumor residues in 2 patients remained unchanged for 51 and 52 months since operation, respectively. CONCLUSIONS For various extra-pelvic IVLs, the 4 types of surgical strategies including less invasive options are feasible, providing these are selected by a guideline base on the tumor extension and morphology. The proposed guideline is believed to accommodate more patients receiving less invasive surgery without compromising the curative effect.
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Affiliation(s)
- Hua Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Jing Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Qiaowei Lin
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Yong Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Yun Zhao
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Hanxing Tong
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Ruiqin Tu
- Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Demin Xu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
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Akinseye OA, Nayyar M, Das P. Uterine intravenous leiomyomatosis with femoral vein, intracaval, intracardiac and pulmonary artery extension. Future Cardiol 2019; 16:27-32. [PMID: 31766884 DOI: 10.2217/fca-2019-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a 54-year-old female with recently diagnosed multiple cardiac thrombi and pulmonary embolism that was treated with thrombolytics and anticoagulants. She presented again with worsening dyspnea and was found to have persistent large cardiac thrombi on echocardiogram. Surgical findings revealed a single right atrial mass originating from inferior vena cava and extending into the pulmonary artery. The mass was successfully removed. Final pathology revealed a benign smooth muscle and vascular mass with estrogen and progesterone receptor positivity favoring uterine intravenous leiomyoma. She was discharged on warfarin and leuprolide therapy. This diagnosis requires a high index of suspicion, especially in a middle-aged woman with right atrial mass and history of an existing leiomyoma, hysterectomy or myomectomy.
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Affiliation(s)
- Oluwaseun A Akinseye
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Mannu Nayyar
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Pranab Das
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Abstract
RATIONALE Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign. PATIENT CONCERNS A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy. DIAGNOSES Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made. INTERVENTIONS The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully. OUTCOMES Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence. LESSONS The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.
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Luo X, Li R, Li Z. Combined transthoracic echocardiography and contrast‐enhanced ultrasonography to trace intravenous leiomyomatosis with intracardiac extension. Echocardiography 2019; 36:1573-1576. [PMID: 31260144 DOI: 10.1111/echo.14424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/05/2019] [Accepted: 06/05/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xianghong Luo
- Department of Echocardiography Shanghai General Hospital Shanghai Jiaotong University Shanghai China
| | - Rongjuan Li
- Department of Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Zhaojun Li
- Department of Ultrasound Shanghai General Hospital Shanghai Jiaotong University Shanghai China
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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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Liu J, Liang M, Ma G, Liu X, Cheng N, Cao D, Yu C, Du S, Miao Q, Zhang C. Surgical treatment for intravenous-cardiac leiomyomatosis. Eur J Cardiothorac Surg 2019. [PMID: 29514177 DOI: 10.1093/ejcts/ezy084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES There are few published studies on the rare disorder of intravenous-cardiac leiomyomatosis (IVCL). This study aimed to propose an individualized strategy for surgical treatment of IVCL. METHODS In this retrospective study, we reviewed 50 patients who had undergone IVCL removal from November 2002 to October 2017 in our hospital. IVCL was classified as Type A-E according to the extent and size, with Type E being the most severe. Clinical manifestations, surgical features and follow-up data were analysed. RESULTS Of the 50 patients in this series, 8 had Type A IVCL, 8 Type B, 29 Type C, 2 Type D and 3 Type E IVCL. One-stage removal of IVCL was performed via laparotomy without cardiopulmonary bypass (CPB) in the 8 patients with Type A, 1-stage tumour resection via sternolaparotomy under deep hypothermic arrest in 7 of the 8 patients with Type B and IVCL removal via sternolaparotomy under CPB, with 27 also under deep hypothermic arrest, in all 29 patients with Type C. Sixteen of the patients with Type C IVCL underwent staged procedures, 13 a 1-stage procedure and 21 required hepatic mobilization. All patients with Type C or E cases underwent 1-stage tumour removal via sternolaparotomy under deep hypothermic arrest. All 50 patients survived surgery. IVCL was confirmed postoperatively by histology. Ten patients had residual tumours; 9 of which did not progress. No deaths occurred during 47.8 ± 38.4 (range 1-177) months of follow-up. CONCLUSIONS The only known curative treatment for IVCL is surgery. Herein, we present an individualized strategy for selecting surgical treatment.
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Affiliation(s)
- Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Liang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingrong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ninghai Cheng
- Department of Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- Department of Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shunda Du
- Department of Hepatic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Li W, Zhang X, Zhang T, Jiang J, He Z, Zhang X. Intravenous Lymphatic Cyst in Inferior Vena Cava-A Rare Cause of Budd-Chiari Syndrome. Ann Vasc Surg 2018; 57:274.e1-274.e3. [PMID: 30500636 DOI: 10.1016/j.avsg.2018.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022]
Abstract
A case with an extremely rare intravenous cystic lesion in the suprahepatic inferior vena cava was reported, which originated from the lymphatic system and had induced Budd-Chiari syndrome. To the best of our knowledge, this is the first report of a benign cystic lesion originating from the wall of a suprahepatic inferior vena cava which results in Budd-Chiari syndrome.
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Affiliation(s)
- Weihao Li
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China.
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Zhibin He
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
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Kim JH, Baek JH. A Challenging Case of Intracardiac Leiomyomatosis Accompanied by Pseudo-Meigs Syndrome Originating from Uterine Leiomyoma. Ann Vasc Surg 2018; 55:309.e5-309.e8. [PMID: 30217716 DOI: 10.1016/j.avsg.2018.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pseudo-Meigs syndrome is an unusual condition involving pelvic tumors, excluding ovarian fibroma, and is associated with ascites and hydrothorax. Pseudo-Meigs syndrome originating from uterine leiomyoma is an even rarer condition. Intravenous leiomyomatosis originating from uterine tumors, which extend from the inferior vena cava to the right heart chambers, is also extremely rare. CASE REPORT This report presents an extremely rare case of intravenous leiomyomatosis with intracardiac extension accompanied by Pseudo-Meigs syndrome caused by uterine leiomyoma. To the best of our knowledge, this is the first reported case of two different rare conditions originating simultaneously from one common pelvic benign tumor. We could only partially resect the tumor owing to its firm adherence to the vessel wall. It is crucial to remember that a pelvic neoplasm in a woman with various manifestations, such as hydrothorax, ascites, intravascular leiomyomatosis, intracardiac mass, and even elevated CA125 levels, does not always imply malignancy. All the accompanying symptoms can be resolved by simple surgical removal of the mass. CONCLUSIONS Accurate preoperative assessment and detailed preparation for the surgery according to the nature of the tumor may yield successful results.
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Affiliation(s)
- Jung Hee Kim
- Department of Thoracic & Cardiovascular Surgery, Daegu Veterans Hospital, Daegu, Korea
| | - Jong Hyun Baek
- Department of Thoracic & Cardiovascular Surgery, Yeungnam University Medical Center, Daegu, Korea.
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Hernández-Flórez C, Jojoa-Jojoa RI, García-Peña ÁA, Bohórquez-Rodríguez WR. Leiomiomatosis intravascular gigante con extensión a cavidades cardíacas. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Cheng BC, Chen CI, Lai CC, Chao CM. Intravenous leiomyomatosis with intracardiac extension. QJM 2018; 111:133-134. [PMID: 29048548 DOI: 10.1093/qjmed/hcx198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B-C Cheng
- Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - C-I Chen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - C-M Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan and Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
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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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