Intravenous leiomyomatosis: a case report emphasizing the vascular component

Abstract

470 Brief reports cellular stroma. The S-100 positive cells were conReferences sidered myoepithelial in nature, possibly representing differentiated basal cells as they were also positive for cytokeratins.We conclude that S-100 immunostaining is of no value in identifying the outer layer of cells that persists in benign proliferative prostatic lesions and is typically absent from around malignant acini (Kovi 1985); this is in contrast to the usefulness of the technique in breast pathology (Egan et al. 1987). The histogenesis of the basal cells in the prostatic acini remains unclear.We report a case of intravenous leiomyomatosis extending from the ovarian vein to the right atrium. Immunohistochemical studies confirmed that the tumour not only consisted of smooth muscle elements, but also of vascular components, findings which suggest an origin in the wall of the uterine vein.

Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis

“…Histological variants of IVL, similar to those of conventional leiomyoma, have been described [4,8,9]. An angiomatoid pattern [16,19], resulting from the presence of thick-walled blood vessels within the leiomyomatous proliferation may also occur, as in our case 3.…”

“…Despite its cytohistological benignity, it represents the most biologically aggressive counterpart of leiomyomatosis, because of the vascular invasion, and the metastatic potentiality. The vascular invasion may occur as the result of either microscopic permeation of small vessels or massive growth within large veins [3,4,5,8,9,16,18,19,20,21,23,25]. Examples of uterine metastasizing leiomyoma and intravenous leiomyomatosis were first described by Steiner [24] and Marshall and Morris [17].…”

Intracardiac leiomyomatosis: a comprehensive analysis of 194 cases

“…Given that the reproductive history was not mentioned in most cases (79.4%), its relation to this disorder cannot be specified. It is postulated that ICLM arises from an invasive uterine myoma or from the vascular wall [8,16,17]. Approximately 83.5% of the patients had undergone a previous hysterectomy/myomectomy or had a coexisting uterine leiomyoma, suggesting uterine leiomyoma with vascular invasion as the origin of this lesion.…”

“…Macroscopically, ICLM originating from the uterus usually has a serpentine appearance, with iliac or ovarian vein extension into the IVC and RA. In contrast, a few patients with ICLM originating from the venous smooth muscle wall itself have been reported [3,[17][18][19][20]28]. The tumour is generally smooth and rubbery, with a greyish-white or rusty colour, with or without an intumescent intracardiac head [21].…”

“…Mitoses are not evident, and hardly any cellular irregularity or nuclear pleomorphism is found. Occasionally, atypical histopathological features, such as angioleiomyoma [17,19], lipoleiomyoma [48], lymphangioleiomyoma [78] and borderline leiomyoma [25,49], have been described.…”