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

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.

[1]  H. Okazawa,et al.  A Novel Diagnostic Strategy Using 16α-[18F]-Fluoro-17-β-Estradiol (18F-FES) PET/MRI to Achieve Complete Resection of Intravenous Leiomyomatosis in Reproductive-Age Women. , 2017, Clinical nuclear medicine.

[2]  Chih-Jen Tseng,et al.  Intravenous leiomyomatosis of the uterus: A clinicopathological analysis of nine cases and literature review. , 2017, Taiwanese journal of obstetrics & gynecology.

[3]  H. Schäfer,et al.  Case report of an intracaval leiomyomatosis 10 months after complete hysterectomy , 2017, International journal of surgery case reports.

[4]  Jianqun Yu,et al.  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. , 2016, Oncology letters.

[5]  Jie Xiao,et al.  The value of (18)F-FDG PET/CT in the diagnosis of uterine intravenous leiomyomatosis extended into the right atrium. , 2016, Hellenic journal of nuclear medicine.

[6]  P. Park,et al.  Intravenous Leiomyomatosis: An Unusual Intermediate between Benign and Malignant Uterine Smooth Muscle Tumors , 2016, Modern Pathology.

[7]  Chunxiao Zhou,et al.  Successful en bloc venous resection with reconstruction and subsequent radiotherapy for 2 consecutive recurrences of intravenous leiomyoma—a case report , 2016, BMC Cancer.

[8]  U. Demirkılıç,et al.  Huge Intravascular Tumor Extending to the Heart: Leiomyomatosis , 2015, Case reports in surgery.

[9]  P. Hui,et al.  Intravenous Leiomyomatosis Revisited: An Experience of 14 Cases at a Single Medical Center , 2015, International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists.

[10]  P. Russell,et al.  Intravenous leiomyomatosis with intracardiac extension - a review of diagnosis and management with an illustrative case. , 2013, Surgical oncology.

[11]  Renyuan Li,et al.  Intracardiac leiomyomatosis: a comprehensive analysis of 194 cases. , 2013, Interactive cardiovascular and thoracic surgery.

[12]  K. Matsuo,et al.  Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein. , 2012, Fertility and sterility.

[13]  Baocun Sun,et al.  Intravenous leiomyomatosis of the uterus: a clinicopathologic study of 18 cases, with emphasis on early diagnosis and appropriate treatment strategies. , 2011, Human pathology.

[14]  Chung-Yi Yang,et al.  Intravenous leiomyomatosis with intracardiac extension. , 2009, Internal medicine.

[15]  M. Esmaeilzadeh.,et al.  Recurrent intracardiac leiomyomatosis. , 2007, The Canadian journal of cardiology.

[16]  F. Scaravilli,et al.  Intravenous leiomyomatosis extending from the inferior caval vein to the pulmonary artery. , 2007, The Journal of thoracic and cardiovascular surgery.

[17]  M. Velinovic,et al.  Intravenous leiomyomatosis with extension to the heart: rare or underestimated? , 2005, The Journal of thoracic and cardiovascular surgery.

[18]  Satoshi Okayama,et al.  Intravenous leiomyomatosis extending into the right ventricle associated with pulmonary metastasis and extensive arteriovenous fistula. , 2004, Journal of the American College of Surgeons.

[19]  Young Tae Kim,et al.  Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature. , 2003, Gynecologic oncology.

[20]  F. Wierrani,et al.  Intravenous leiomyomatosis of the uterus. , 2002, Anticancer research.

[21]  C. Karakousis,et al.  Intravenous leiomyomatosis with cardiac extension: tumor thrombectomy through an abdominal approach. , 2000, Journal of vascular surgery.

[22]  L. Cea‐Calvo,et al.  Images in cardiovascular medicine. Uterine intravenous leiomyomatosis extending through the inferior vena cava into the right cardiac cavities. , 2000, Circulation.

[23]  I. Kronzon,et al.  Pulmonary embolectomy for intravenous uterine leiomyomatosis. , 1994, American heart journal.

[24]  B. Rigney,et al.  Intravascular leiomyomatosis of the uterus. A case report. , 1982, Connecticut medicine.

[25]  W. Nasser,et al.  Resection of a leiomyoma of the inferior vena cava that produced tricuspid valvular obstruction. , 1974, The Journal of thoracic and cardiovascular surgery.