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Case report
Intravenous leiomyomatosis: the first reported case of intraoperative intracaval embolisation of tumour to the right atrium
  1. Gillian A Corbett1,
  2. Catherine O'Gorman1,2 and
  3. Waseem Kamran1
  1. 1Department of Gynaecological Surgery, Saint James's Hospital, Dublin, Ireland
  2. 2Department of Gynaecology, Trinity College Dublin, Dublin, Ireland
  1. Correspondence to Dr Gillian A Corbett; Gillian.corbett{at}ucdconnect.ie

Abstract

Intravenous leiomyomatosis is extremely rare. This case describes a 42-year-old woman who presented with abdominal distension, cyclical bloating and urinary retention. Preoperative imaging showed a multilobulated uterine mass. Following multidisciplinary team discussion, a complete staging surgery consisting of midline laparotomy, total hysterectomy and bilateral salpingo-oophrectomy was performed. Intraoperatively, a large multilobulated uterine mass was noted with engorgement of the infundibulopelvic ligaments due to intravascular extension of tumour. On removal of the uterus, the patient desaturated and became hypotensive. Intraoperative transoesophageal echocardiography revealed mass extending from the inferior vena cava (IVC) into the right atrium (RA). The cardiothoracic surgical team retrieved a worm-like mass extending from the IVC into the RA. Histopathological examination diagnosed a large uterine leiomyoma with intravenous leiomyomatosis. The mass from the RA was a bland spindle cell tumour which matched the uterine mass histopathologically. Intravenous leiomyomatosis is a rare variant of uterine leiomyoma. Although intracardiac extension has been described, this is the first case of intraoperative embolisation of pelvic tumour to the RA at hysterectomy.

  • cardiothoracic surgery
  • obstetrics and gynaecology
  • adult intensive care
  • anaesthesia
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Footnotes

  • Contributors All authors were involved in the conceiving and designing this case report. All authors revised it critically for important intellectual content.The primary author (GAC) collected patient details, and penned the manuscript draft. The secondary author (CO’G) reviewed and amended the draft and corresponded with the patient to obtain consent and patient perspective account. The senior and supervising author (WK) supported the primary and secondary authors (GAC and CO’G) through drafting the article, critically analysed, reviewed and approved the final manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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