Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography

Abstract

Abstract.We herein report a case of low-grade endometrial stromal sarcoma with intracardiac extension in a 58-year-old woman with a uterine tumor with intravascular involvement. The tumor was suspected preoperatively to be an endometrial stromal sarcoma by magnetic resonance imaging. The extent of intravascular involvement was determined to be below the level of the renal veins on preoperative contrast-enhanced computed tomography (CT). However, perioperative echography revealed that the tumor extended to the right atrium. An emergency cardiotomy with extracorporeal circulation was required. The risk of tumor embolism was reduced through transection of the inferior vena cava, but the tumor was difficult to remove completely. Postoperative hormonal therapy reduced the size of the residual tumor and no recurrence was detected for 1 year. The preoperative contrast-enhanced CT was unable to detect the free-floating intravascular tumor. This case illustrates a limitation of CT and indicates that accurate determination of the tumor extent for planning a surgical strategy in similar cases should be performed using multiple imaging methods.

Case Report: Low-grade endometrial stromal sarcoma with intravenous and intracardiac extension: a case after misdiagnosis of endometrial stromal nodule as submucosal fibroid

“…CT and MRI examinations are powerful tools for early detection of cardiac and vascular involvement. However, there are also cases in which CT or MRI were unable to detect the free−floating intravascular tumor but were detected accidentally by TEE ( 12 , 22 ), suggesting that for patients with possible major vascular metastasis, TEE should be stressed and applied as early as possible. Several case reports pointed out that TEE can also guide the doctor to determine whether the cardiac mass is removed completely during the surgery ( 6 ).…”

A case of a recurrent low-grade endometrial stromal sarcoma extending to the inferior vena cava (IVC) after the primary fertility-sparing surgery

“…Imaging examination, like enhanced CT and MRI, are often used for the preoperative assessment to evaluate the size, location, origin and the extent of tumors [ 2 ]. However, Nogami et al (2016) reported that the sensitivity of CT was limited for the detection of free-floating lesions in the bloodstream [ 9 ]. In most cases, intracardiac or intravascular tumors grow freely within the endovascular system without invading tissues [ 9 , 10 ].…”

“…However, Nogami et al (2016) reported that the sensitivity of CT was limited for the detection of free-floating lesions in the bloodstream [ 9 ]. In most cases, intracardiac or intravascular tumors grow freely within the endovascular system without invading tissues [ 9 , 10 ]. In our case, we planned strategies preoperatively and involving a multidisciplinary team, including cardiovascular surgeons.…”

Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Multidisciplinary Approach

“…In the present case, we used a multidisciplinary approach to evaluate our patient. Nogami et al further highlighted that preoperative contrast-enhanced CT was unable to detect the free-floating intravascular tumors, thus illustrating a significant limitation of CT, and suggested that a more accurate determination of the extent of a specific tumor should be performed using multiple imaging methods when planning a surgical strategy [ 6 ]. Operative success is based on full anatomical exposure and complete vascular control, which is best achieved by full sternolaparotomy.…”

“…In general, the intracardiac extension of LG-ESS is rare and most cases derive from renal cell carcinoma, nephroblastoma, colon adenocarcinoma, melanoma, hepatocellular carcinoma, or bronchogenic carcinoma [ 3 ]. Only 22 cases of advanced LG-ESS have been reported in which the great vessels were invaded and a tumor of the inferior vena cava (IVC) formed [ 3 – 6 ]. However, earlier studies show that >50% of intravenous LG-ESS cases exhibit intracardiac extension [ 7 ].…”