Intravascular (post-hysterectomy) leiomyoma (IVL) as late tumor thrombus within the inferior vena cava (IVC)-A rare case primarily imposing as IVC thrombus originating from left renal vein after former left nephrectomy status.

Abstract

INTRODUCTION:

Intravascular leiomyoma is a rare type of myoma. It was firstly described by Birch-Hirschfeld in 1896, however, its intracardiac subtype was firstly reported by Durck in 1907. Most patients are asymptomatic. The tumor invades mostly the tributaries of the inferior vena cava (IVC) with upward extension that may approach the intracardiac space.

AIM:

By means of a scientific case report, a patient with the very rare diagnosis of an endocaval leiomyoma thrombus post-hysterectomy is described based on the clinical experiences obtained in the specific case management and selective references from the literature.

CASE PRESENTATION:

A 48-years old female was diagnosed with intravascular tumor growth within the IVC with intracardiac extension using chest and abdominal CT scan, ECG and echocardiography which was approached by an interdisciplinary (vascular and cardiothoracic) surgical intervention (278 min) including heart-lung machine (99 min) with favorable postoperative result (R0 resection status with mid-term outcome, no recurrent tumor growth). Histopathological investigation diagnosed leiomyoma origin already from ovarian vein most likely in context to the former hysterectomy (3 years ago).

DISCUSSION AND CONCLUSION:

Intravascular leiomyoma is a benign tumor with invasive tendency, which can be considered a diagnostic and therapeutic challenge. It should be thoroughly investigated to be planned for a radical surgical removal. By possible adherence to the intraabdominal or -thoracic organs, an interdisciplinary and eventually step-wise surgical approach (combining vascular, abdominal, thoracic and heart surgery as well as gynecology and urology), which can be demanding, is recommended to be seriously considered to i) reliably achieve R0 resection status and, thus, ii) provide best outcome, quality of life and prognosis.

• Authors: M Ghanem, F Meyer, D Jechorek, V Schoeder, A Ignatov, M Fadel, Z Halloul
• Journal: Pathology, research and practice (Pathol Res Pract) Vol. 215 Issue 6 Pg. 152359 (Jun 2019) ISSN: 1618-0631 [Electronic] Germany
• PMID: 30853174 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2019. Published by Elsevier GmbH.

Topics

• Carcinoma, Renal Cell (pathology)
• Female
• Humans
• Hysterectomy (adverse effects)
• Kidney Neoplasms (pathology)
• Leiomyoma (pathology)
• Middle Aged
• Neoplasms, Multiple Primary (pathology)
• Neoplastic Cells, Circulating (pathology)
• Nephrectomy
• Uterine Neoplasms (pathology, surgery)
• Vena Cava, Inferior (pathology)