One-stage surgery for removal of intravascular leiomyomatosis extending to right ventricle. Issue 11 (March 2018)

• Record Type: Journal Article
• Authors: Chiang, Ching-Shu; Chen, Po-Lin; Kuo, Tzu-Ting; Chen, I-Ming; Wu, Nai-Yuan; Chang, Hsiao-Huang
• Other Names: Mistiaen. Wilhelm section editor.
• Is Part Of: Medicine. Volume 97:Issue 11(2018)
• Publication Date: 2018-03
• Subjects: intracardiac tumor -- intracaval tumor -- intravascular leiomyomatosis -- uterine leiomyoma; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000010051
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Intravascular leiomyomatosis (IVL) is a rare nonmalignant tumor that can be fatal if untreated. Patient concerns: A 49-year-old nulliparous Asian woman who underwent hysterectomy and left salpingo-oophorectomy for multiple uterine leiomyomas 18 months prior presented complaining of intermittent palpitation and chest tightness for approximately 1 month. Echocardiography revealed a large mobile tumor mass extending from the inferior vena cava (IVC) to the right atrium that partially obstructed IVC flow and tricuspid inflow. Thoracicabdominopelvic computed tomography revealed a left adnexal tumor (4.8 × 2.5 cm) causing intravascular obstruction extending from the left internal iliac vein to the IVC, right atrium, and right ventricle. Diagnosis: IVL with right heart involvement Interventions: Under cardiopulmonary bypass, a one-stage surgery combining sternotomy and laparotomy was performed. The tumor was approached and extracted via sternotomy, and tumor detachment and removal of residual tumors was accomplished via laparotomy. Outcomes: A firm, smooth, and regularly shape tumor 15.5 × 5.5 × 2.5 in size was completely removed and histopathologically confirmed as IVL. The patient tolerated the surgical procedure well and no postoperative complication was noted. Lessons: We describe a one-stage surgical approach to completely remove an IVL extending to the right ventricle.