Therapeutic Strategy of Intravenous Leiomyomatosis with Intracaval and Intracardiac Extension in 18 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GUOLi-long , DIAOYong-peng , LIANLi-shan , LIUChang-wei ,  LIYong-jun

Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, China;

Corresponding author：

LIYong-jun, Email: yongj_93@hotmail.com

Keywords：

Intravenous leiomyomatosis; Diagnosis; One-stage surgery; Two-stage surgery; Complication; Prognosis

DOI：

10.7507/1007-9424.20140078

Video：

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Objective To summarize the diagnosis and management of intravenous leiomyomatosis, and to compare effect of the one-stage surgery and two-stage surgery. Methods Clinicopathological data of 18 patients hospitalized in Peking Union Medical College Hospital who were diagnosed as intravenous leiomyomatosis with intracaval and intracardiac extension during Jan. 2002 to Sep. 2013 were collected, and some indexes of the one-stage surgery group and two-stage surgery group were compared, including blood loss, blood transfusion, operation time, period of stay in ICU, hospital stay, and hospitalization expense. Results All the patients were diagnosed as intravenous leiomyomatosis pathologically after operation. Of the 18 patients, 6 (33.3%) patients underwent one-stage surgery and 12 (66.7%) patients underwent two-stage surgery. There were no significant difference on blood loss, blood transfusion, operation time, period of stay in ICU, hospital stay, and hospitalization expense (P > 0.05). There were some patients suffered from complication, including 1 case of pleural effusion, 1 case of recurrent laryngeal nerve injury, 1 case of pulmonary infection in one-stage surgery group; 1 cases of arrhythmia, 2 cases of intestinal obstruction, 2 cases of pleural effusion in two-stage surgery group. No significance had be found in incidence rate of complication between one-stage surgery group and two-stage surgery group (P=1.000). Tumors of 2 patients who underwent two-stage surgery had developed before the second surgery, increasing the difficulty and risk of the second surgery. Three cases of one-stage group were followed-up for 48-63 month (the median time was 62.0 months), 10 cases in two-stage group were followed-up for 1-43 month (the median time was 19.5 months). During the followed-up period, occurrence happened in 1 case of two-stage group, but without death in all cases. Conclusions Both one-stage surgery and two-stage surgery are effective and safe. Taking physical and psychological endurance of patients into consideration, one-stage surgery is highly recommended if the patient is in good status and can tolerate the strike brought by the surgery.

Citation： GUOLi-long, DIAOYong-peng, LIANLi-shan, LIUChang-wei, LIYong-jun. Therapeutic Strategy of Intravenous Leiomyomatosis with Intracaval and Intracardiac Extension in 18 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 335-340. doi: 10.7507/1007-9424.20140078 Copy

1.	Fasih N, Prasad Shanbhogue AK, Macdonald DB, et al. Leiom-yomas beyond the uterus:unusual locations, rare manifestations[J]. Radiographics, 2008, 28(7):1931-1948.
2.	Virzì G, Ragazzi S, Bussichella F, et al. Intravenous leiomyoma-tosis extending from the inferior caval vein to the pulmonary artery[J]. J Thorac Cardiovasc Surg, 2007, 133(3):831-832.
3.	Nishizawa J, Matsumoto M, Sugita T, et al. Intravenous leiomyo-matosis extending into the right ventricle associated with pulmonary metastasis and extensive arteriovenous fistula[J]. J Am Coll Surg, 2004, 198(5):842-843.
4.	Liu B, Liu C, Guan H, et al. Intravenous leiomyomatosis with inferior vena cava and heart extension[J]. J Vasc Surg, 2009, 50(4):897-902.
5.	Kikuchi C, Asami F, Hanzawa K, et al. Successful surgical remo-val of an intravenous leiomyoma extending to the right atrium 4 years after hysterectomy[J]. Eur J Cardiothorac Surg, 2013, 43(6):1262.
6.	Low G, Rouget AC, Crawley C. Case 188:intravenous leiomyo-matosis with intracaval and intracardiac involvement[J]. Radiology, 2012, 265(3):971-975.
7.	Mertens R, Valdés F, Muñoz C, et al. Pelvic intravenous leiom-yomatosis with intracardiac extension:report of two cases[J]. Rev Med Chil, 2012, 140(7):906-909.
8.	Zhang Y, Zhu J, Wang C, et al. Multimodality treatment of two cases of intracardiac leiomyomatosis with enormous mass in the abdominopelvic cavity[J]. Expert Rev Anticancer Ther, 2013, 13(2):137-141.
9.	Bodner K, Bodner-Adler B, Wierrani F, et al. Intravenous leiomyomatosis of the uterus[J]. Anticancer Res, 2002, 22(3):1881-1883.
10.	Stolf NA, dos Santos GG, Haddad VL. Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection[J]. Rev Hosp Clin Fac Med Sao Paulo, 1999, 54(5):159-164.
11.	Stolf NA, Santos GG, Haddad VL, et al. Successful one-stage resection of intravenous leiomyomatosis of the uterus with extension into the heart[J]. Cardiovasc Surg, 1999, 7(6):661-664.
12.	Nam MS, Jeon MJ, Kim YT, et al. Pelvic leiomyomatosis with intracaval and intracardiac extension:a case report and review of the literature[J]. Gynecol Oncol, 2003, 89(1):175-180.
13.	Peng HJ, Zhao B, Yao QW, et al. Intravenous leiomyomatosis:CT findings[J]. Abdom Imaging, 2012, 37(4):628-631.
14.	Dal Cin P, Quade BJ, Neskey DM, et al. Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24)[J]. Genes Chromosomes Cancer, 2003, 36(2):205-206.
15.	Quade BJ, Dal Cin P, Neskey DM, et al. Intravenous leiomyomatosis:molecular and cytogenetic analysis of a case[J]. Mod Pathol, 2002, 15(3):351-356.
16.	Kir G, Cetiner H, Gurbuz A, et al. Immunohistochemical profile of intravenous leiomyomatosis[J]. Eur J Gynaecol Oncol, 2004, 25(4):481-483.
17.	Kir G, Kir M, Gurbuz A, et al. Estrogen and progesterone expre-ssion of vessel walls with intravascular leiomyomatosis; discussion of histogenesis[J]. Eur J Gynaecol Oncol, 2004, 25(3):362-366.
18.	Ariza A, Cerra C, Hahn IS, et al. Intravascular leiomyomatosis of the uterus. A case report[J]. Conn Med, 1982, 46(12):700-703.
19.	Harris LM, Karakousis CP. Intravenous leiomyomatosis with cardiac extension:tumor thrombectomy through an abdominal approach[J]. J Vasc Surg, 2000, 31(5):1046-1051.
20.	Castelli P, Caronno R, Piffaretti G, et al. Intravenous uterine leiomyomatosis with right heart extension:successful two-stage surgical removal[J]. Ann Vasc Surg, 2006, 20(3):405-407.
21.	Leitman M, Kuperstein R, Medalion B, et al. A highly unusual right atrial mass presented in two women[J]. Eur J Echocardiogr, 2008, 9(6):833-834.
22.	Fujiwara K, Haba M, Noguchi Y, et al. Successful one-stage surgical removal of intravenous uterine leiomyomatosis with right heart extension[J]. Jpn J Thorac Cardiovasc Surg, 2003, 51(9):462-465.
23.	Singh T, Lamont PM, Otton GR, et al. Intravenous leiomyoma-tosis with intracardiac extension:first reported case in Australia[J]. Heart Lung Circ, 2010, 19(1):50-52.
24.	Bahary CM, Gorodeski IG, Nilly M, et al. Intravascular leiomyomatosis[J]. Obstet Gynecol, 1982, 59(6 Suppl):73S-77S.
25.	Nili M, Liban E, Levy MJ. Tricuspid stenosis due to intravenous leiomyomatosis-a call for caution:case report and review of the literature[J]. Tex Heart Inst J, 1982, 9(2):231-235.
26.	Demirkiran F, Sal V, Kaya U, et al. Intravenous leiomyoma with extension to the heart:a case report and review of the literature[J]. Case Rep Obstet Gynecol, 2013, 2013:602407.
27.	Valdés Devesa V, Conley CR, Stone WM, et al. Update on intravenous leiomyomatosis:report of five patients and literature review[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 171(2):209-213.
28.	Xu HS, Firoj KM, Inamdar KY, et al. Uterine leiomyoma exten-sion into right atrium[J]. J Card Surg, 2013, 28(6):702.
29.	Lam PM, Lo KW, Yu MY, et al. Intravenous leiomyomatosis:two cases with different routes of tumor extension[J]. J Vasc Surg, 2004, 39(2):465-469.
30.	Mitsuhashi A, Nagai Y, Sugita M, et al. GnRH agonist for intravenous leiomyomatosis with cardiac extension. A case report[J]. J Reprod Med, 1999, 44(10):883-886.

1. Fasih N, Prasad Shanbhogue AK, Macdonald DB, et al. Leiom-yomas beyond the uterus:unusual locations, rare manifestations[J]. Radiographics, 2008, 28(7):1931-1948.
2. Virzì G, Ragazzi S, Bussichella F, et al. Intravenous leiomyoma-tosis extending from the inferior caval vein to the pulmonary artery[J]. J Thorac Cardiovasc Surg, 2007, 133(3):831-832.
3. Nishizawa J, Matsumoto M, Sugita T, et al. Intravenous leiomyo-matosis extending into the right ventricle associated with pulmonary metastasis and extensive arteriovenous fistula[J]. J Am Coll Surg, 2004, 198(5):842-843.
4. Liu B, Liu C, Guan H, et al. Intravenous leiomyomatosis with inferior vena cava and heart extension[J]. J Vasc Surg, 2009, 50(4):897-902.
5. Kikuchi C, Asami F, Hanzawa K, et al. Successful surgical remo-val of an intravenous leiomyoma extending to the right atrium 4 years after hysterectomy[J]. Eur J Cardiothorac Surg, 2013, 43(6):1262.
6. Low G, Rouget AC, Crawley C. Case 188:intravenous leiomyo-matosis with intracaval and intracardiac involvement[J]. Radiology, 2012, 265(3):971-975.
7. Mertens R, Valdés F, Muñoz C, et al. Pelvic intravenous leiom-yomatosis with intracardiac extension:report of two cases[J]. Rev Med Chil, 2012, 140(7):906-909.
8. Zhang Y, Zhu J, Wang C, et al. Multimodality treatment of two cases of intracardiac leiomyomatosis with enormous mass in the abdominopelvic cavity[J]. Expert Rev Anticancer Ther, 2013, 13(2):137-141.
9. Bodner K, Bodner-Adler B, Wierrani F, et al. Intravenous leiomyomatosis of the uterus[J]. Anticancer Res, 2002, 22(3):1881-1883.
10. Stolf NA, dos Santos GG, Haddad VL. Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection[J]. Rev Hosp Clin Fac Med Sao Paulo, 1999, 54(5):159-164.
11. Stolf NA, Santos GG, Haddad VL, et al. Successful one-stage resection of intravenous leiomyomatosis of the uterus with extension into the heart[J]. Cardiovasc Surg, 1999, 7(6):661-664.
12. Nam MS, Jeon MJ, Kim YT, et al. Pelvic leiomyomatosis with intracaval and intracardiac extension:a case report and review of the literature[J]. Gynecol Oncol, 2003, 89(1):175-180.
13. Peng HJ, Zhao B, Yao QW, et al. Intravenous leiomyomatosis:CT findings[J]. Abdom Imaging, 2012, 37(4):628-631.
14. Dal Cin P, Quade BJ, Neskey DM, et al. Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24)[J]. Genes Chromosomes Cancer, 2003, 36(2):205-206.
15. Quade BJ, Dal Cin P, Neskey DM, et al. Intravenous leiomyomatosis:molecular and cytogenetic analysis of a case[J]. Mod Pathol, 2002, 15(3):351-356.
16. Kir G, Cetiner H, Gurbuz A, et al. Immunohistochemical profile of intravenous leiomyomatosis[J]. Eur J Gynaecol Oncol, 2004, 25(4):481-483.
17. Kir G, Kir M, Gurbuz A, et al. Estrogen and progesterone expre-ssion of vessel walls with intravascular leiomyomatosis; discussion of histogenesis[J]. Eur J Gynaecol Oncol, 2004, 25(3):362-366.
18. Ariza A, Cerra C, Hahn IS, et al. Intravascular leiomyomatosis of the uterus. A case report[J]. Conn Med, 1982, 46(12):700-703.
19. Harris LM, Karakousis CP. Intravenous leiomyomatosis with cardiac extension:tumor thrombectomy through an abdominal approach[J]. J Vasc Surg, 2000, 31(5):1046-1051.
20. Castelli P, Caronno R, Piffaretti G, et al. Intravenous uterine leiomyomatosis with right heart extension:successful two-stage surgical removal[J]. Ann Vasc Surg, 2006, 20(3):405-407.
21. Leitman M, Kuperstein R, Medalion B, et al. A highly unusual right atrial mass presented in two women[J]. Eur J Echocardiogr, 2008, 9(6):833-834.
22. Fujiwara K, Haba M, Noguchi Y, et al. Successful one-stage surgical removal of intravenous uterine leiomyomatosis with right heart extension[J]. Jpn J Thorac Cardiovasc Surg, 2003, 51(9):462-465.
23. Singh T, Lamont PM, Otton GR, et al. Intravenous leiomyoma-tosis with intracardiac extension:first reported case in Australia[J]. Heart Lung Circ, 2010, 19(1):50-52.
24. Bahary CM, Gorodeski IG, Nilly M, et al. Intravascular leiomyomatosis[J]. Obstet Gynecol, 1982, 59(6 Suppl):73S-77S.
25. Nili M, Liban E, Levy MJ. Tricuspid stenosis due to intravenous leiomyomatosis-a call for caution:case report and review of the literature[J]. Tex Heart Inst J, 1982, 9(2):231-235.
26. Demirkiran F, Sal V, Kaya U, et al. Intravenous leiomyoma with extension to the heart:a case report and review of the literature[J]. Case Rep Obstet Gynecol, 2013, 2013:602407.
27. Valdés Devesa V, Conley CR, Stone WM, et al. Update on intravenous leiomyomatosis:report of five patients and literature review[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 171(2):209-213.
28. Xu HS, Firoj KM, Inamdar KY, et al. Uterine leiomyoma exten-sion into right atrium[J]. J Card Surg, 2013, 28(6):702.
29. Lam PM, Lo KW, Yu MY, et al. Intravenous leiomyomatosis:two cases with different routes of tumor extension[J]. J Vasc Surg, 2004, 39(2):465-469.
30. Mitsuhashi A, Nagai Y, Sugita M, et al. GnRH agonist for intravenous leiomyomatosis with cardiac extension. A case report[J]. J Reprod Med, 1999, 44(10):883-886.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Therapeutic Strategy of Intravenous Leiomyomatosis with Intracaval and Intracardiac Extension in 18 Cases

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