Intravenous leiomyomatosis with intracardiac extension depicted on computed tomography and magnetic resonance imaging scans: A report of two cases and a review of the literature

Abstract

Abstract. Intravenous leiomyomatosis (IVL) is defined as a benign smooth muscle tumor, growing within systemic veins. IVL with intracaval and intracardiac extension has rarely been reported in radiological and oncological journals. The present study describes 2 cases of IVL extending from the inferior vena cava to the right atrium and ventricle, and discusses the imaging findings and differential diagnosis of this tumor entity. The two patients, who complained of palpitations, shortness of breath or syncope, were surgically treated, with complete resection of the cardiac and intracaval tumors. Pathological examinations were suggestive of IVL. The postoperative course of the two patients was uneventful, and no signs of recurrence were observed on follow-up. Computed tomography and magnetic resonance imaging played a vital role in the diagnostic process and presurgical assessment. The results of the present study indicate that IVL should be considered upon presentation of a soft mass in systemic veins, even when the mass extends to the right cardiac chambers, in female patients, particularly in patients with a history of uterine myoma.

Benign Metastasizing Leiomyoma of the Heart

“…Previous studies have reported these tumors often stain positively for both estrogen and progesterone receptors [8][9][10][11][12]. Our patient's cardiac mass was 95% and 20% immuno-reactive for estrogen and progesterone, respectively, consistent with a uterine origin.…”

“…However, this study found no significant relationship between the type of primary surgery and BML diagnosis with respect to timing of surgery or site of metastasis. Three out of the four other recorded cases of BML to the heart had multiple lung metastases [7][8][9][10][11][12]. In these case reports, BML was found in the right atrium, interventricular septum, tricuspid valve and right ventricle [8].…”

“…Our patient was not on estrogen replacement therapy, and has been followed for continued surveillance of recurrence. Treatments with aromatase inhibitors, anti-estrogens, and luteinizing hormone releasing hormone (LHRH) agonists are effective in both the regression of the leiomyomatous tumors and prophylaxis against recurrence [12][13][14][15][16][17].…”

Uterine leiomyomatosis with intracardiac extension

“…Patients commonly present with gynaecological symptoms such as abnormal uterine bleeding and pelvic pain 2. They may also complain of cardiac symptoms such as syncope, dysponea, chest pain and peripheral odema.…”

Tumor Obstruction of the Inferior Vena Cava and Its Tributaries: Diagnosis, Features of Surgical Interventions, the Results of Surgical Treatment. Part I

“…В литературе последних лет активно обсуждаются варианты хирургической тактики именно при тромбозах позадипеченочного и наддиафрагмального отделов НПВ [11,12,17,21,22]. При удалении наддиафрагмальных опухолевых тромбов академик М. И. Давыдов и соавт.…”