Intravenous leiomyomatosis misdiagnosed with large thrombosis in inferior vena cava

Han, Young-Sin; Chung, Youn‐Jee; Shin, Inhye; Park, Jeong Yoon; Shim, Suhyun; Hijazi, Ayah; Song, Jongkeun; Cho, Hyun Hee; Kim, Mee‐Ran

doi:10.1016/j.tjog.2021.01.019

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…Conventional ultrasound has many advantages, such as radiation-free, real-time imaging, safety, convenience, and affordability, though it still has limited sensitivity to detect blood flow, especially in tiny blood vessels with low velocity ( 6 , 7 ).Researchers have affirmed the feasibility of ultrasound in IVL diagnosis ( 8 ). However, conventional ultrasound often misdiagnoses IVL as a thrombus and other diseases ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Wang

et al. 2022

Front. Oncol.

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ObjectiveIntravenous leiomyomatosis (IVL) is a rare disease, and few studies have focused on the diagnostic value of contrast-enhanced ultrasound (CEUS) in this condition. This study aimed to investigate the diagnostic value of CEUS in IVL and summarize the specific CEUS characteristics of IVL.Materials and MethodFrom December 2016 to March 2021, 93 patients admitted to our hospital with inferior vena cava (IVC) occupying lesions were prospectively enrolled and underwent detailed ultrasound multi-modality examinations, including conventional and contrast-enhanced ultrasound scans. The diagnostic value of CEUS and conventional ultrasound (CU) in IVL was compared, and the specific IVL signs were summarized.ResultsAmong the 93 patients with inferior vena cava mass, 67 were IVL while 26 were non-IVL. The inter-observer agreement of the two senior doctors was good, with Kappa coefficient = 0.71 (95% CI: 0.572–0.885). The area under the ROC curve of CU for IVL diagnosis was 0.652 (95% CI: 0.528–0.776), and its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate were 61.1%, 69.2%, 63.4%, 83.7%, 40.9%, 38.8%, and 30.8%, respectively. The area under curve (AUC) for IVL diagnosis by CEUS was 0.807 (95% CI: 0.701–0.911), and the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate were 82.0%, 84.6%, 82.8%, 93.2%, 64.7%, 15.4%, and 17.9%, respectively. In CEUS mode, “sieve hole sign” and “multi-track sign” were detected in 57 lesions, and the detected rate was higher than that of CU (https://loop.frontiersin.org/people/1014187 < 0.01).ConclusionCEUS can better show the fine blood flow inside the IVL, which is important for IVL differential diagnosis. Moreover, CEUS can obtain more information about IVL diagnosis than CU, compensating for the shortcomings of CU in detecting more blood flow within the lesion. Thus, this technique has great significance for IVL diagnosis.

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Section: Introductionmentioning

confidence: 99%

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Wang

et al. 2022

Front. Oncol.

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“…Intravascular leiomyomatosis (IVL) is a histologically-benign, rare mesenchymal tumor which can develop from the veins of the uterus, extend into the inferior vena cava and ultimately into the right side of the heart, resulting in death.The aetiology of IVL is unclear and discussion centres around two hypothesis, namely,the proliferation of vascular smooth muscle cells and the direct invasion of uterine leiomyoma into the muscular veins and diffusion along the vascular lumen [ 6 , 7 ].According to the reported cases, about 83. 5-94.3% of IVL patients had uterine fibroids or previous history of uterine fibroid surgery as reported [ 4 , 5 ], so most scholars believe that IVL is caused by uterine leiomyoma directly invading the veins of myometrium.…”

Section: Discussionmentioning

confidence: 99%

“Evolution” of intravascular leiomyomatosis

Chen,

Yang,

Zhao

2023

BMC Women's Health

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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.

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“…The aetiology of IVL is unclear and discussion centres around two hypothesis, namely,the proliferation of vascular smooth muscle cells and the direct invasion of uterine leiomyoma into the muscular veins and diffusion along the vascular lumen [3,4].According to the reported cases, majority patients of IVL have a history of uterine leiomyoma or surgery, so most scholars believe that IVL is caused by uterine leiomyoma directly invading the veins of myometrium.Similarly, the patient we report here obtained IVL after hysteroscopic myomatectomy.In addition, imaging examination, intraoperative exploration and postoperative pathology all indicated that IVL was connected to the uterus, which also supported this theory.Therefore, we have reason to believe that our patient's IVL was derived from a previous submucosal myoma.…”

Section: Discussionmentioning

confidence: 99%

“Evolution” of intravascular leiomyomatosis

Chen

Yang

Zhao

2023

Preprint

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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.

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Intravenous leiomyomatosis misdiagnosed with large thrombosis in inferior vena cava

Cited by 7 publications

References 12 publications

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

“Evolution” of intravascular leiomyomatosis

“Evolution” of intravascular leiomyomatosis

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