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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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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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Peng J, Zhong F, Zhu Y, Zhang M, Zhang M, Lu C, Wang Y, Qi X, Wang C, Li G. Clinical analysis of uterine intravenous leiomyomatosis: A retrospective study of 260 cases. J Obstet Gynaecol Res 2021; 47:4357-4364. [PMID: 34525488 PMCID: PMC9293182 DOI: 10.1111/jog.15013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/31/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
Methods We collected the clinical data of 260 patients admitted to the hospital from April 2003 to September 2019 with pathologically confirmed intravenous leiomyomatosis (IVL) and followed up with these patients regularly. Univariate and multivariate logistic regression analyses were carried out on the relevant recurrence factors. Results A total of 166 patients were regularly followed up, the median follow‐up time was 36 (range 2–168) months, 14 (5.4%) patients eventually relapsed, and the median recurrence time was 8.5 (range 2–42) months. The univariate analysis showed that age (p = 0.003) and surgical type (p < 0.001) were associated with recurrence, and multivariate regression analysis demonstrated that surgical type was the only factor associated with recurrence (p < 0.001, OR 20.01). Conclusions The use of gonadotrophin releasing hormone agonist (GnRHa) cannot reduce the postsurgical recurrence rate of patients with UIVL. Compared to total hysterectomy and bilateral salpingo‐oophorectomy (TH‐BSO), total hysterectomy (TH) does not increase the odds of recurrence, but the chance of recurrence with tumorectomy (TE) is 20 times higher than that of TH‐BSO.
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Affiliation(s)
- Jing Peng
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Fangfang Zhong
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yuemeng Zhu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Mingxing Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Meng Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Chong Lu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yumeng Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Xingling Qi
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Congwen Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Guiling Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
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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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Xu Y, Gao X, Yang C, Liu J, Jin B, Shang D. Intravascular Leiomyomatosis Extending to Right Atrium: A Rare Caused Syncope. Ann Vasc Surg 2019; 65:287.e7-287.e10. [PMID: 31743782 DOI: 10.1016/j.avsg.2019.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/18/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022]
Abstract
Intravascular leiomyomatosis (IVL) is a variant of leiomyoma characterized by intravascular proliferation of a histologically benign smooth muscle tumor extending beyond the uterus into distant great vessels or the heart. It is a rare disease and results in death. Here, we reported the case of 48-year-old, otherwise well woman, who presented to the emergency department with syncope. Pulmonary computed tomography (CT) demonstrated a large low-density shadow originating from the inferior vena cava (IVC) extending into the right atrium (RA). Magnetic resonance venography (MRV) showed that a neoplasm was "snakelike," which completely occluded the right internal iliac vein (RIIV), the common iliac vein (CIV), and IVC. A multidisciplinary team of specialists consisting of vascular surgeons, cardiac surgeons, gynecologists, anesthesiologists, and radiologists reviewed the history, clinical examination findings, and diagnostic imaging of the patient. A decision was made to proceed with one-stage surgery (resection of thoracoabdominal tumor extension at one operative setting). After surgery, the patient's vital signs were restored, and her symptoms were disappeared. She was discharged on hospital day 21 without complications. One-stage surgical approach to completely remove an IVL with RA involvement is an optimal choice if the patient's physical condition permits.
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Affiliation(s)
- Yingjiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, People's Republic of China; Key Laboratory of Metabolism and Molecular Medicine, The Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China
| | - Xiujuan Gao
- Department of Cerebrovascular Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, People's Republic of China
| | - Chao Yang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Jianyong Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Bi Jin
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
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Zhang HX, Chen ZX, Nan J, Lei JQ. Imaging Features of Uterine Leiomyomatosis with the Inferior Vena Cava and the Right Atrium Involvement. Chin Med J (Engl) 2018; 131:867-868. [PMID: 29578134 PMCID: PMC5887749 DOI: 10.4103/0366-6999.228239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hong-Xia Zhang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Zi-Xian Chen
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jiang Nan
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jun-Qiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
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Rosa P, Pidhorecky I. A Case of Intravenous Leiomyomatosis with Involvement of a Renal Vein. Ann Vasc Surg 2018; 53:271.e11-271.e13. [DOI: 10.1016/j.avsg.2018.05.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 11/24/2022]
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Yang C, Fang H, Yang Y, Cai F, Zheng H, Jin B, Li Y, Liu Z, Zayed MA. Diagnosis and surgical management of inferior vena cava leiomyomatosis. J Vasc Surg Venous Lymphat Disord 2018; 6:636-645. [DOI: 10.1016/j.jvsv.2018.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
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