Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series

Abstract

Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.

Clinical analysis of uterine intravenous leiomyomatosis: A retrospective study of 260 cases

“…Intravenous leiomyomatosis (IVL) is a clinically rare benign smooth muscle tumor that generally originates from uterine leiomyoma or myometrium 1 and can spread along uterine or ovarian veins to the iliac vein, 2 renal vein, 3 inferior vena cava, 4 right atrium, right ventricle, 5 and even the pulmonary artery 6 and subclavian vein. 7 Preoperative diagnosis is difficult, and no consensus has been reached about its clinical diagnosis and treatment.…”

Treatment of Disseminated Intravenous Leiomyomatosis With ALK Targeting Crizotinib: A Successful Case Report

“…14 Reports on the use of estrogen receptor antagonists or gonadotropinreleasing hormone have shown mixed benefits. [15][16][17][18] To our knowledge, there is no report that involved the use of precision medicine with targeted therapy for IVL.…”

Intravenous leiomyomatosis: Case series and review of the literature

“…For more advance stages, depending on the tumoral vascular extension and the suitability for the patient to surgery, early treatment is recommended with a single or double procedure by multidisciplinary team [31] , [32] . If the tumor reaches cardiac level, sternotomy is followed by abdominal resection by laparotomy.…”

“…Difficulty of surgery depends more on the degree of tumors invasion and deformation of the vessel walls, than with its length. Complications of major surgical operations are death, hemorrhage due to peri-tumoral hypervascularization, infections, embolism and the usual post laparotomy complications [31] , [36] , [37] . To prevent hemorrhage, preoperative embolization of the uterine arteries or uterine arteries ligation may be appropriate [28] .…”