“Evolution” of intravascular leiomyomatosis

Abstract

Background Intravenous leiomyomatosis (IVL) is a rare and specific type of smooth muscle tumor that is histologically benign but has a malignant biological behavior. It is commonly associated with a history of uterine leiomyomas. Case presentation A 36-year-old woman, G1P1, presented to the hospital with left lower abdominal pain for 2 months and she has accepted hysteroscopic myomectomy about 1 year ago. Ultrasound venography, echocardiography and computed tomography venography (CTV) of inferior vena cava were performed, which revealed IVL located in left intramural myometrium walls growing along the left ovarian vein reaching the level of the lumbar 5-sacral 1 disc. Laparoscopic bilateral salpingo-oophorectomy and hysterectomyis were scheduled. The IVL in the left ovarian vein and parauterine venous plexus were detected and excised completely during surgery. IVL was diagnosed by postoperative pathology and immunohistochemistry. The patient recovered well after surgery. No surgical-related or anesthesia-related complications occurred.The 3-month follow-up CTV of inferior vena cava and echocardiography examination revealed normal. Conclusions The cause of IVL is unknown, this observation demonstrates that hysteroscopic myomectomy might lead to the occurrence of IVL.

Intravascular Leiomyoma Considered Preoperatively as Uterine Sarcoma: A Rare Case

“… 5–8 It is characterized by the presence of vascular elongation and benign smooth muscle lesions invading the pelvic and systemic vascular systems in a worm-like manner. 9 Most of these tumors are diagnosed by cardiologists when they extend into the inferior vena cava, right heart, or pulmonary artery. 10 , 11 Nonspecific clinical features and variable imaging findings of intravenous leiomyoma, which makes preoperative diagnosis difficult.…”