Intravenous leiomyomatosis with extension to the heart: Rare or underestimated?

Kočica, Mladen J.; Vranes, M; Kostić, Dušan; Kostic, Natasa Kovacevic; Lačković, Vesna; Mihajlovic, Vesna Bozic; Velinović, Miloš; A, Mikić; Kalezic, Nevena Dimitrijevic

doi:10.1016/j.jtcvs.2005.08.021

Cited by 65 publications

(62 citation statements)

References 4 publications

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“…1 Overall, smooth muscle tumors of the heart are extremely rare. Three different clinical settings for cardiac smooth muscle tumors have been reported: intravenous cardiac extension of pelvic leiomyomas, 2 benign metastasizing leiomyomas from the uterus, 1,3,4 and primary cardiac leiomyomas and leiomyosarcomas. 5 Here we report a rare entity of metastasizing leiomyoma to the heart with review of the literature.…”

Section: Introductionmentioning

confidence: 99%

Metastasizing Leiomyoma to Heart

Consamus

Reardon

Ayala³

et al. 2014

Methodist DeBakey Cardiovascular Journal

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Section: Introductionmentioning

confidence: 99%

Metastasizing Leiomyoma to Heart

Consamus

Reardon

Ayala³

et al. 2014

Methodist DeBakey Cardiovascular Journal

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“…Birch-Hirschfeld first presented a case of intracardiac extension of IVL in 1896 [3], and Durck first presented a case of itracardiac extension of IVL in 1907, with more than 100 reported cases since early 1900s [4]. Since IVL is a rare case, it is usually not in the mind of paractitioners to include in the differential diagnosis of an intracardiac tumor which may lead to the misdiagnosis of the case.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Leiomyoma with Extension to Heart: A Case Report

Firoj¹,

Sasank²

2016

J Rare Dis Diagn Ther

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Leiomyoma is a benign smooth muscle tumor that very rarely becomes cancer. Uterine leiomyoma or uterine fibroid is a benign tumor of uterus arising from smooth muscle cells of myometrium. Intravenous leiomyoma with intracardiac extension is a very rare clinical entity usually develops exclusively in women arising from either uterine venous wall or uterine leiomyoma [1] which is commonly misdiagnosed as primary cardiac tumor, such as Myxoma. We report the case of 48 year old woman with intravenous leiomyoma arising from left common iliac vein and extended to the heart through the inferior vena cava presented with symptoms of hemodynamic disorder. The patient had the history of uterine fibroid. Thoracoabdominal CT was performed to finalize the diagnosis. The intravenous tumor with its extension to the right atrium was ultimately resected via cardiotomy without the need of prolonged hypothermia during cardiopulmonary bypass. Keywords:Myxoma; Cardiopulmonary bypass; Leiomyoma; Inferior vena cava Case ReportA 48 year old woman referred to our department from the department of obstetrics and gynecology who came for the routine checkup after showing a lesion in the right atrium which considered being a blood clot or a primary cardiac tumor. She had the history of total hysterectomy 5 years ago in a local hospital due to a large uterine fibroid. She was fine for the last 5 years after the surgery, but recently she started to have symptoms of breathlessness, swelling of lower limbs, intermittent abdominal pain and giddiness.On physical examination she was afebrile, conscious, cooperative, and normotensive with slight engorgement of the right jugular vein. Pelvic vascular ultrasound revealed thrombotic features in inferior vena cava and pelvic veins. On further investigation, computed tomography showed a large mass arising from the iliac veins, mainly the left side. It was confirmed that the patient has lesion arising from the pelvic veins and extended via the inferior vena cava up to the right atrium (Figures 1 and 2). After the proper and illustrative diagnosis, it was confirmed that the patient has a leiomyoma with extension to the right atrium. Patient was explained about her condition and the way of treatment. After the consent papers were signed, she was ready for the operation.The surgical approach was through median sternotomy. The usual process of establishing cardiopulmonary bypass was performed for any emergency purposes of mass bleeding. The aortic cannulation was done and connected to the extracorporeal machine with a single superior venous cannulation into the superior vena cava. The right atrium was palpated and felt the tumor. After the temperature was slightly

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“…La asociación de miomatosis o masa pelviana en la ecografía Doppler, con "trombosis" de vena iliaca o cava u ocasionalmente ovárica 5 , con fl ujo detectable al interior del trombo tumoral debe despertar la sospecha 1,7 . La tomografía Figura 4.…”

Section: Discussionunclassified

“…El abordaje amplio, con exposición simultánea de los órganos torácicos y abdominales y el uso de circulación extracorpórea, permite la resección segura y en una sola etapa del tumor 6 como en los dos casos descritos en esta comunicación. La resección en dos etapas ha sido descrita con más frecuencia 1 , pero no parece presentar ventajas y se ha reportado progresión del tumor nuevamente hacia el corazón en pocas semanas 2 . La recurrencia es posible y ha sido descrita en plazos muy variables 2,4,9 .…”

Section: Discussionunclassified

Leiomiomatosis intravenosa de origen pelviano con extensión intracardiaca: Reporte de dos casos

et al. 2012

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Intravenous leiomyomatosis with extension into the heart is an infrequent entity described in 1907. Its clinical presentation is non-specifiHistológicamente el tumor se caracteriza por predominio de células musculares lisas. Existen teorías de su origen, como el crecimiento de cé-lulas originadas en el miometrio hacia los senos venosos miometriales o la proliferación de células musculares lisas de la pared de venas uterinas 1,2 . Se desconoce por qué el crecimiento del tumor es a través de los vasos sin infi ltrar sus paredes. Algunos estudios sugieren que se originarían en leiomiomas uterinos con una translocación entre un segmento del brazo largo del cromosoma 12 y un segmento del brazo largo del cromosoma 14, t(12;14)(q15;q24). La presencia de una copia extra del 12q15-qter y o la pérdida del 14q24-qter podrían ser los eventos genéticos críticos que llevarían a estas lesiones a la invasión vascular y proliferación 3 . Su presentación clínica es variable y va desde hallazgo asintomático hasta insufi ciencia cardiaca, síncope o muerte por obstrucción del tracto de salida del ventrículo derecho.A continuación se describen dos casos de leimiomatosis intravenosa (LI) de origen pelviano y compromiso cardiaco tratados en nuestra Institución durante los últimos 25 años. Caso clínico 1Paciente de 35 años, con historia de disnea progresiva por un año y una panhisterectomía 8 meses antes por extensa miomatosis uterina, evolucionando con fístula vésico-vaginal. El estudio histopatológico informó leiomioma con degeneración hialina y localizaciones secundarias en pelvis y omento. Tres meses previos al traslado, su situación clínica empeoró presentando disnea de reposo, hipoxemia, hepatomegalia, ictericia, ascitis

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Intravenous leiomyomatosis with extension to the heart: Rare or underestimated?

Cited by 65 publications

References 4 publications

Metastasizing Leiomyoma to Heart

Metastasizing Leiomyoma to Heart

Intravenous Leiomyoma with Extension to Heart: A Case Report

Leiomiomatosis intravenosa de origen pelviano con extensión intracardiaca: Reporte de dos casos

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