Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

Lidia Castagneto Gissey, Germano Mariano, Layla Musleh, Pasquale Lepiane, Marco Colasanti, Roberto L. Meniconi, Federico Ranocchi, Francesco Musumeci, Mario Antonini, Giuseppe M. Ettorre

Research output: Contribution to journalReview article

Abstract

Background: Uterine leiomyomas represent the gynecological neoplasm with the highest prevalence worldwide. This apparently benign pathological entity may permeate into the venous system causing the so-called intravenous leiomyomatosis of the uterus (IVL). IVL may seldom extend to large caliber veins and reach the right cardiac chambers or pulmonary arteries and cause signs of right sided congestive heart failure and sudden death. Due to its low incidence, however, IVL with intracardiac extension is often misdiagnosed resulting in deferred treatment. No consensus has been obtained regarding the standard surgical approach to be used for this rare condition. We describe the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and provide a review of the literature, analyzing management and surgical outcomes. Case presentation: We present the case of a 46-year-old premenopausal woman presenting with lower-extremity edema, recurrent syncopes and a history of subtotal hysterectomy for multiple uterine fibroids. She was diagnosed with pelvic recurrence of uterine leiomyomatosis and IVL with cardiac involvement. A two-stage surgical excision of the intracardiac-intracaval mass and pelvic leiomyomatosis was performed. The patient had an uneventful recovery and no evidence of recurrence was observed on follow-up. Conclusions: By virtue of the rarity of the present pathology, awareness is widely scarce and diagnosis is often delayed. Early recognition is difficult due to initial aspecific and subtle clinical manifestations. Nevertheless, suspicion should be held high in premenopausal women with known history of uterine leiomyomata, presenting with cardiovascular symptoms and evidence of a free-floating mass within the right cardiac chambers. In-depth imaging is crucial for defining its anatomical origin and relations. Prompt surgical treatment with radical excision of pelvic and intravenous leiomyomatosis guarantees favorable outcomes and excellent prognosis with low rates of recurrence, whereas delayed diagnosis and treatment exposes to increased risk of congestive heart failure and sudden death.

Original languageEnglish
Article number118
JournalBMC Surgery
Volume17
Issue number1
DOIs
Publication statusPublished - Nov 29 2017

Keywords

  • Cardiopulmonary bypass
  • Hysterectomy
  • Intracardiac leiomyomatosis
  • Intravenous leiomyomatosis
  • Uterine leiomyoma

ASJC Scopus subject areas

  • Surgery

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    Castagneto Gissey, L., Mariano, G., Musleh, L., Lepiane, P., Colasanti, M., Meniconi, R. L., Ranocchi, F., Musumeci, F., Antonini, M., & Ettorre, G. M. (2017). Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review. BMC Surgery, 17(1), [118]. https://doi.org/10.1186/s12893-017-0306-y