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Zheng T, Huang C, Xia Q, He W, Liu Y, Ye H. Intravenous leiomyomatosis in the inferior vena cava and right atrium with pulmonary benign metastasizing leiomyoma secondary to a pelvic arteriovenous fistula: a case report and literature review. Cardiovasc Pathol 2024:107685. [PMID: 39142442 DOI: 10.1016/j.carpath.2024.107685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/25/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND To report the diagnosis and treatment of a rare disease of intravenous leiomyomatosis (IVL) originating from the uterus, growing in the inferior vena cava (IVC) and extending into the right atrium (RA) associated with a pelvic arteriovenous fistula (AVF). This is the first reported case of IVL in the IVC and RA with pulmonary benign metastasizing leiomyoma (PBML) secondary to a pelvic AVF despite the use of GnRH agonists in a non-menopausal woman. CASE PRESENTATION The patient was a 50-year-old premenopausal woman with a history of surgical resection for and anti-estrogen conservative drug for pulmonary benign metastasizing leiomyoma (PBML) 5 years. The patient nevertheless developed IVL in the IVC, internal iliac vein and RA accompanied by AVF. Vaginal ultrasound combined with echocardiography and Computerized tomographic venography imaging assists in the diagnosis of IVL combined with AVF, with histopathology and immunohistochemistry ultimately confirming the diagnosis. the patient ultimately was performed with a combination of hysterectomy, bilateral adnexectomy, and resection of tumors in the IVC and RA without cardiopulmonary bypass and sternotomy. CONCLUSION BML may be difficult to control with incomplete removal of the uterus and ovaries even with the use of anti-estrogenic medications, and medically induced AVF resulting from fibroid surgery may accelerate this process and the development of IVL.
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Affiliation(s)
- Tingting Zheng
- Department of Obstetrics and Gynecology, The First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Yichang, Hubei, P.R. 443003, China
| | - Chunyan Huang
- Department of Obstetrics and Gynecology, The First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Yichang, Hubei, P.R. 443003, China
| | - Qin Xia
- Department of Pathology, Wuhan Xiehe Hospital, Huazhong University of Science and Technology School of Medicine, China
| | - Wencong He
- Department of Obstetrics and Gynecology, The First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Yichang, Hubei, P.R. 443003, China
| | - Yufei Liu
- Department of Pathology, The First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Yichang, Hubei, P.R. 443003, China
| | - Hong Ye
- Department of Obstetrics and Gynecology, The First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Yichang, Hubei, P.R. 443003, China.
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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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Magdalena P, Thomas B, Nina P, Alexander R, Martin A, Christoph N, Josif N, Maja Carina N, Stephan P. Successful one-stage resection of intracardiac intravenous leiomyomatosis: A case report. Gynecol Oncol Rep 2023; 48:101243. [PMID: 37520784 PMCID: PMC10372183 DOI: 10.1016/j.gore.2023.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023] Open
Abstract
This case report is about a 47-year-old patient, who was diagnosed with intracardiac intravenous leiomyomatosis and received treatment at our institution. Intravenous leiomyomatosis is a rare, histologically benign, uterine neoplasm, which is characterized by non-invasive intravascular proliferation of smooth muscle cells. Intravenous leiomyomatosis arises from the myometrium and, in its most extensive form, can reach the heart via the pelvic veins and the inferior vena cava, causing hemodynamic complications. Treatment of choice is the complete resection of the tumor, even though there is no consensus on the optimal surgical approach. In this case, complete resection of the tumor was accomplished in a one-stage procedure. The patient recovered well and CT scan did not show any signs of recurrence after five months.
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Affiliation(s)
- Postl Magdalena
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Bartl Thomas
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Poetsch Nina
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Reinthaller Alexander
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Andreas Martin
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Neumayer Christoph
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | - Nanobachvili Josif
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Austria
| | | | - Polterauer Stephan
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
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Li B, Yuan Z, Zhang Y, Li F, Huang L, Yang Z, Liu H, Liu Z. Exploring the role of uterine fibroids in promotion of cardiovascular diseases by diabetes exposure: Findings from national health and nutrition examination survey 1999-2006. Front Cardiovasc Med 2022; 9:975920. [PMID: 36017104 PMCID: PMC9395617 DOI: 10.3389/fcvm.2022.975920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 12/11/2022] Open
Abstract
Objective The relationship between uterine fibroids (UF) and cardiovascular diseases (CVDs) in the diabetes population seemed to remain undetermined in previous studies. This study aims to explore the association between UF and CVDs by using the database from the National Health and Nutrition Examination Survey (NHANES). To further evaluate the connection between UF and CVDs we also tested the potential differences due to diabetes exposure. Materials and methods National Health and Nutrition Examination Survey data (1999–2006) were collected and used in this study. A total of 5,509 individuals were included and analyzed. The student’s t-test and the chi-squared test were used to explore the demographic characteristic between UF and non-UF groups. Logistic regression analysis was performed to determine the odds ratios of UF and covariates. Results Female participants were divided into UF (n = 694, 12.60%) and non-UF (n = 4,815, 87.40%) groups. The incidence of CVDs in UF patients (n = 245, 35.30%) were higher than non-UF individuals (n = 776, 16.12%) (p < 0.001). In addition, each subtype of CVDs were also different, which contains hypertension (33.29 vs. 15.31%, p < 0.001), heart failure (1.59 vs. 0.52%, p < 0.01), angina (2.59 vs. 0.62%, p < 0.001), heart attack (1.73 vs. 0.58%, p < 0.01) and coronary heart disease (1.44 vs. 0.54%, p < 0.01). The odds ratios of CVDs according to logistic regression were 2.840 (95% CI: 2.387–3.379) for UF patients (p < 0.001), while the odds ratios (ORs) were 1.438 (95% CI: 1.175–1.760) after taking account for the age, body mass index (BMI), diabetes, race, education, and annual family income (p < 0.001). In addition, secondary analysis indicated more adverse effects in by UF exposure on CVDs risk among non-diabetes individuals (OR = 1.389, 95% CI = 1.124–1.718, p < 0.01) than diabetes patients (p = 0.063). Conclusion Overall, UFs were positively associated with CVDs, and this effect seems blunted by diabetes exposure.
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Affiliation(s)
- Bin Li
- Department of Cardiology, Xiamen Chang Gung Hospital, School of Medicine, Huaqiao University, Xiamen, China
| | - Zhen Yuan
- Department of Cardiology, Xiamen Chang Gung Hospital, School of Medicine, Huaqiao University, Xiamen, China
| | - Yizhi Zhang
- Department of Cardiology, Xiamen Chang Gung Hospital, School of Medicine, Huaqiao University, Xiamen, China
| | - Feng Li
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Lin Huang
- Pharmaceutical and Medical Technology College, Putian University, Putian, China
| | - Zhihui Yang
- Pharmaceutical and Medical Technology College, Putian University, Putian, China
| | - Haiyue Liu
- Xiamen Key Laboratory of Genetic Testing, Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Zuheng Liu
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.,Xiamen Key Laboratory of Cardiac Electrophysiology, Department of Cardiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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