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OBJECTIVE: To investigate the feasibility of abdominal surgical resection of intracardiac leiomyomatosis.METHODS: The clinical data of 4 cases of intracardiac leiomyomatosis performed in zhongshan Hospital,Fudan University from December 2015 to August 2017 were analyzed retrospectively. RESULTS: Four patients underwent onestage surgery through an abdominal approach,without death. The operative time was 185-420(315.3 ± 86.4) min.Extracorporeal circulation time was 22-175(71.8±60.4)min and blood loss was 600-3000(1475.0±941.7)mL. Acute renal failure occurred in one of the patients after operation,the rest had no surgical complications. After 8-26 months of follow-up,there was no sign of recurrence and metastasis. CONCLUSION: One-stage surgery of intracardiac leiomyomatosis through an abdominal approach is feasible. But,how to determine the indications of surgery remains to be further explored and studied.
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OBJECTIVE: To investigate the clinical characteristics,diagnosis and treatment of intravenous leiomyomatosis(IVL).METHODS: The clinical data of 9 IVL treated at Women's Hospital,Zhejiang University School of Medicine from January 2013 to December 2017 were analyzed retrospectively. All the cases were followed up.RESULTS: Out of 8702 patients with uterine leiomyoma,9 patients were diagnosed with IVL. Most patients complained of pelvic mass,and 6 patients had enlarged uterus. Preoperative imaging examination demonstrated parametrial mass in 5 cases. All nine cases were confined to the pelvic cavity except for one who had lung metastasis. Two cases had myomectomy,and seven underwent hysterectomy. The lesions were dendritic,dumbbell-shaped,elliptical or elongate in four cases. Nine cases had a mean follow-up of 28.2 months,and recurrence occurred in two cases.CONCLUSION: The obvious enlargement of uterus and parametrial mass are important features of IVL. It is difficult to diagnose preoperatively. Identifying the morphological features of lesions during operation can improve the diagnostic accuracy. Total hysterectomy is the first choice of treatment and long-term follow-up is also needed.
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Objective Uterine intravenous leiomyomatosiswas a rare type of uterus tumors.Because of the lack of knowledge about the ultrasonic patterns of this kind of disease,misdiagnosis frequently happens.Reviewing the cases and relevant researcheswas helpful to understand the disease and figure it out inultrasonic images.Methods Six cases of patients with uterine intravenous leiomyomatosis were reviewed which werehospitalized in Beijing Obstetrics and Gynecology Hospital during 2014 to 2016.All of the patients underwentultrasound examinations before surgery.The ultrasound findings,clinical presentations and pathological features of the 6 patients were evaluated.Results In 6 patients with uterine intravenous leiomyomatosis,3 cases were solid tumors,located in the cervix region and para uterine region,withirregular veinvascular inside;3 cases performance as multiple tumorlocated in dilated uterine vein,active tumor embolus were found in inferior vena cavain one of the 3 cases.Conclusions Uterine intravenous leiomyomatosisis found to be a solid mass located in the cervix region and para uterine region.The internal fissure of solid tumor is an important feature.Tumor extending to the iliac vein and inferior vena cava in some cases.Thusit is hard to be diagnosed before surgery by ultrasonography.Moreover,transvaginal ultrasound combined with inferior vena cava ultrasonography and echocardiography has a more obvious advantage in the diagnosis of the uterine intravenous leiomyomatosis.
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To summarize the nursing experience on recurrent intravenous leiomyomatosis with right atrial invasion in one case undergoing thoracoabdominal joint surgery.The key points were muhidisciplinary consultation and collaboration,detailed personalized surgical program and reasonable arrangements.A comprehensive preoperative assessment and psychological counseling was carried out.In the process of operation nosocomial infection was strictly controlled.The patient underwent an 8-hour procedure with 1 000ml intraoperative blood loss and was in good recovery right now.
ABSTRACT
To summarize the nursing experience on recurrent intravenous leiomyomatosis with right atrial invasion in one case undergoing thoracoabdominal joint surgery.The key points were muhidisciplinary consultation and collaboration,detailed personalized surgical program and reasonable arrangements.A comprehensive preoperative assessment and psychological counseling was carried out.In the process of operation nosocomial infection was strictly controlled.The patient underwent an 8-hour procedure with 1 000ml intraoperative blood loss and was in good recovery right now.
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Leiomyomatosis refers to benign smooth muscle cell tumors that often arise from unusual growth patterns and include benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, and intravenous leiomyomatosis. Intravenous leiomyomatosis is the extension of a vascular tumor into the venous channels, whereas disseminated peritoneal leiomyomatosis is characterized by multiple leiomyomas growing along the submesothelial tissues of the abdominopelvic peritoneum. It is extremely rare for intravenous leiomyomatosis and disseminated peritoneal leiomyomatosis to occur simultaneously. A 42-year-old female presented with disseminated peritoneal leiomyomatosis and intravenous leiomyomatosis extended through the inferior vena cava into the right side of the heart. The patient underwent one-stage surgery under simultaneous sternotomy and laparotomy, and radical excision of the tumor was achieved using cardiopulmonary bypass. Here we describe a case in which complete removal of a leiomyomatosis with an unusual growth pattern was successfully performed using one-stage surgery.
Subject(s)
Adult , Female , Humans , Cardiopulmonary Bypass , Heart , Laparotomy , Leiomyoma , Leiomyomatosis , Myocytes, Smooth Muscle , Peritoneum , Sternotomy , Vena Cava, InferiorABSTRACT
A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.
Subject(s)
Female , Humans , Middle Aged , Fluorodeoxyglucose F18/chemistry , Leiomyoma/pathology , Leiomyomatosis/pathology , Lung Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Positron-Emission Tomography , Tomography, X-Ray Computed , Uterine Neoplasms/pathology , Vena Cava, Inferior/pathologyABSTRACT
Intravenous leiomyomatosis (IVL) is extremely rare with just around 300 cases reported in literature. 1 With its unusual growth pattern and clinically aggressive behavior, this benign tumor can masquerade as a malignancy and present a diagnostic challenge. Concurrent uterine fibroids or recent hysterectomy for the same often provides a hint towards the diagnosis. 2 The median interval between hysterectomy and diagnosis of IVL is approximately 4 years. 3 We present a case of IVL detected 10-years post total hysterectomy, bilateral salpingo-oophorectomy (THBSO) and parametriectomy with emphasis on multimodality imaging with multip
Subject(s)
LeiomyomatosisABSTRACT
Son raros los casos de leiomiomas intravenosos con extensión intracardiaca. En pacientes con manifestaciones de sobrecarga de cavidades derechas o quienes debutan con síntomas de insuficiencia cardiaca aguda y cuyos síntomas no mejoran con el manejo convencional, se debe considerar esta entidad, y es importante evaluar de forma integral con estudios de gabinete como electrocardiograma, ecocardiograma, tomografía o resonancia magnética. Reportamos el caso de una mujer de 46 años que manifiesta síntomas de insuficiencia cardiaca aguda e inadecuada respuesta a los fármacos convencionales. Con hallazgos ecocardiográficos de tumoración en atrio derecho que protruye a ventrículo derecho y causa insuficiencia tricuspídea. Por estudio tomográfico se confirma la extensión del tumor a vena cava inferior y ventrículo derecho; se resuelve de forma quirúrgica con resección radical y se confirma la extirpación histológica mediante estudio anatomopatológico.
Cases of intravenous leiomyoma with intracardiac extension are rare. Patients with signs of right-sided overload who present symptoms of acute heart failure and whose symptoms do not improve with conventional management, we must consider this entity. It is important to comprehensively assess with imaging studies such as electrocardiogram, echocardiogram, Tomography (CT scan) or magnetic resonance. The following is a report of the case of a 46 year old woman with symptoms of acute heart failure and inadequate response to conventional drugs. The echocardiographic show findings of a tumor in the right atrium, protruding to the right ventricle causing tricuspid regurgitation. The CT scan confirmed the extent of the tumor to the inferior vena cava and right ventricle, and was resolved surgically with radical resection and histology lineage confirmed by pathologic examination.
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Intravenous leiomyomatosis is a rare benign tumor originating from the uterus that spreads through vessels. In rare cases, intracaval and intracardiac involvement has been described. We report a case of a 64-year-old woman who presented intravenous leiomyomatosis, which originated from the right uterine vein and extended through the inferior vena cava into the right atrium. The tumor was completely removed through a one-stage transabdominal approach with transesophageal echocardiography monitoring. Sparing thoracotomy is important in order to reduce postoperative morbidity and tumor removal by pulling down was technically possible without the risk of embolization.
Subject(s)
Female , Humans , Middle Aged , Echocardiography, Transesophageal , Heart Atria , Leiomyomatosis , Thoracotomy , Uterus , Veins , Vena Cava, InferiorABSTRACT
Objective To improve the diagnosis and therapy level of the uterine intravenous eiomyomatosis, we reported one case involving the right heart and reviewed the relative literatures.Methods and results The patient is 38 years old, she was admitted to hospital with fever, abdominal pain and chest tightness for one week in July 2010. She had a total hysterectomy owing to hysteromyoma in 2003. In July 2010, because she wanted a baby with the method of surrogate pregnancy, so she was injected medicine to stimulate follicle growth in the USA. The medicine was Li ShenBao injection, the total of 12d daily 3 branch (dose not stated). Afterward she couldn't stand fever, abdominal distension and chest tightness, she returned to China for treatment. After she was hospitalized, for diagnosis she got many image examination done, such as B-scan, CT, MRI and PET/CT. Result All image examination found that a massive solid and cystic tumor in the abdominal and pelvic cavity, left kidney hydrocele, ascites, and tumor embolus in the right atrium, inferior caval vein, left renal vein, also bilateral iliac vein. The thoracic-abdominal surgery was carried out, massive tumor was removed, also the tumor embolus in the right atrium and inferior caval vein. The pathological diagnosis was uterine intravenous leiomyomatosis. Conclusion Uterine intravenous leiomyomatosis is a rare disease, involving to heart case is seldomness. In recent years, the case increasing could be related with the usage count of sex hormone in Assisted Reproductive Technology. The imaging examination can give a confident diagnosis, and the final diagnosis depend on pathology. For treatment, surgery is the first choice, and must be thorough to prevent recurrence.
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Intravenous leiomyomatosis (IVL) is a rare benign neoplasm which originates from the smooth muscle cells and is usually confined to the pelvic venous system.Rarely,intracaval and intracardiac extension has been described.Death can occur as a result of intracardiac involvement.We reported 4 cases of IVL with right heart inyolvement (intracardiac leiomyomatosis,ICL).Three of them suffered recurrent sudden syncope,and the other one was totally asymptomatic.All of them were successfully treated through one-stage operation under extracorporeal circulation.
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Objective To observe the ultrasonographic features of intravenous leiomyomatosis (IVL). Methods Ultrasonographic features, pathological results and the clinical manifestations of 7 patients with IVLs were analyzed retrospectively, and the causes of misdiagnosis were discussed as well. Results The median age of 7 IVL patients was 40 years old. Five patients underwent previously hysterectomy due to probable diagnosis of leiomyoma with the mean recurrent time of 13.8 months. Three lesions extended into the right atrium, 3 involved the inferior venous cava and 1 was confined in the pelvis venous. Ultrasonographic findings of IVL included uterine solid lesions with intravascular disease, solid occupied lesions in the pelvis with intravascular disease after hysterectomy, solid occupied lesions in the pelvis, large abdominal vessels and cardiac chambes with intravascular disease after hysterectomy. The main misdiagnosis cause was that IVL had similar ultrasonographic features with hysteromyoma, and intravascular lesions of IVL was hard to detect in the early stage. Conclusion Color Doppler ultrasonography is a valuable imaging mortality for detection and follow-up of IVL.
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A 76-year-old woman presented because of bilateral lower-extremity edema and dyspnea. Transthoracic echocardiography revealed a mobile mass in the right atrium. A right atrial mass associated with heart failure was diagnosed. Surgery was performed. Intraoperative transesophageal echocardiography showed that the mass was contiguous with the inferior vena cava. However, the primary lesion was unclear. Therefore, only the intracardiac mass was resected. The margins of the residual tumor were marked with clips. Computed tomography performed immediately after surgery revealed a clip in structures contiguous with the region from a uterine myoma to the inferior vena cava. Intravenous leiomyomatosis was diagnosed on histopathological examination of the resected specimens. Computed tomography 6 months after surgery showed that the clip had moved from the inferior vena cava to a vein contiguous with the uterus. The tumor regressed slightly. Close follow-up is required.
ABSTRACT
Intravenous leiomyomatosis (IVL) is a rare, benign tumor that originates from the uterus. IVL is usually confined to the pelvic venous system, but it travels into the inferior vena cava (IVC) in 10% of cases and even into the heart in 3% of cases. We present a case of successful resection of recurrent IVL with right atrium extension. We used only an abdominal incision and transesophageal echocardiography (TEE) guidance. A 40-year-old female patient visited our hospital with recurrent IVL. She had a history of total abdominal hysterectomy and right salpingo-oophorectomy due to IVL performed one year prior. On computed tomography (CT) and ultrasonography, IVL was found to involve both ovarian veins, the left renal vein, and the IVC extending to the right atrial junction. Using intraoperative TEE monitoring, we could see that IVL was not attached to the vascular wall. After creating a midline abdominal incision, we removed the tumor through the enlarged ovarian vein and ovary. The patient had an uneventful recovery and was discharged home on the ninth postoperative day.
Subject(s)
Adult , Female , Humans , Echocardiography, Transesophageal , Heart , Heart Atria , Hysterectomy , Leiomyomatosis , Ovary , Renal Veins , Uterus , Veins , Vena Cava, InferiorABSTRACT
Intravenous leiomyomatosis (IVL) is rare and it is characterized by intravascular nodular masses of benign smooth muscle that may extend to variable site such as uterus, pelvic veins, inferior vena cava, right sided heart and eventually lung. We experienced an unusual case of IVL originating from the uterus and extending to the lung parenchyma and treated by combined surgery, so we report it with a brief review of the literatures.
Subject(s)
Heart , Leiomyomatosis , Lung , Muscle, Smooth , Uterus , Veins , Vena Cava, InferiorABSTRACT
Intravenous leiomyomatosis of the uterus is a rare tumor that presents with benign histological features. It is characterized by intravenous proliferation of smooth muscle cells originating from the uterus that sometimes extends to the inferior vena cava and the right heart. It may spread elsewhere, usually to the lung. The first case of intravenous leiomyomatosis was described in 1896 by Birsh-Hirshfeld,1) and only a few cases have been reported since then. Its pathogenesis and optimal treatment have not yet been established. We report a case of metastasizing leiomyomatosis found to have multiple nodular densities in both lower lung fields seven months after myomectomy. In another case the leiomyomatosis was confined to the pelvis after a laparoscopy assisted vaginal hysterectomy, the patient is alive without evidence of disease. Here we provide a detailed report of two cases of intravenous leiomyomatosis of the uterus with a brief review of the literature.
Subject(s)
Female , Humans , Heart , Hysterectomy, Vaginal , Laparoscopy , Leiomyomatosis , Lung , Myocytes, Smooth Muscle , Pelvis , Uterus , Vena Cava, InferiorABSTRACT
Intravenous leiomyomatosis is an uncommon benign tumor arising from either the uterine venous wall or uterine leiomyoma. Although this tumor is usually confined to the pelvic cavity, sometimes it can extend into the cardiac cavity and brings on sudden death. We report a case of intravenous leiomyomatosis extending into the right atrium, right ventricle and both pulmonary arteries by seeding. The tumor was detected with transthoracic echocardiography and appropriately diagnosed by transesophageal echocardiography and cardiac MRI. Entire tumor was successfully removed by one-stage radical surgery under cardiopulmonary bypass.
Subject(s)
Cardiopulmonary Bypass , Death, Sudden , Echocardiography , Echocardiography, Transesophageal , Heart Atria , Heart Ventricles , Leiomyoma , Leiomyomatosis , Magnetic Resonance Imaging , Pulmonary ArteryABSTRACT
Intravenous leiomyomatosis (IVL) is rare and it is characterized by intravascular nodular masses of histologically benign smooth muscle that may extend along the inferior vena cava or reaching the right-sided cardiac chamber, and eventually the lung. Although histologically benign, IVL might be malignant in its mode of behavior. We report a case of IVL that grew in a vessel of myometrium of uteri.
Subject(s)
Animals , Female , Mice , Leiomyomatosis , Lung , Muscle, Smooth , Myometrium , Uterus , Vena Cava, InferiorABSTRACT
Intravenous leiomyomatosis (IVL) is a rare neoplasm that is characterized by a histologically benigh-looking smooth muscle cell tumor growing within the uterine and the extrauterine venous system. We report here on patient had a uterine and extrauterine leiomyoma that extended into the right atrium through the inferior vena cava. A 19-year old female patient was suffering from dyspnea, swelling of the lower extremity, abdominal pain and abdominal distension. She had total abdominal hysterectomy performed at a private clinic due to uterine leiomyoma 4 months previously. 4 months after the first operation, we again completely excised the recurred intraperitoneal tumor mass. At 6 months after the re-operation, the tumor mass recurred intraperitoneally. A preoperative abdominal CT scan and an echocardiogram revealed multiple tumor masses that were located intraperitoneally and they extended to the right atrium. We performed intraperitoneal tumor excision and removal of the intravenous tumor mass via the right iliac vein by the one-stage approach. At present, the patient has shown a clinically favorable outcome except for local recurrence of tumor mass in the pelvic cavity. The cure of this complex disease emphasizes the need for a planned systemic approach by a multidisciplinary surgical team. We present here an unusual case of intravenous leiomyomatosis that originated from the uterus and it extended to the inferior vena cava and right atrium.