Intravenous leiomyomatosis: Difference between revisions

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__NOTOC__
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{{SI}}
{{SI}}
 
{{CMG}} {{AE}} {{Sonia Sandeep Js}} {{Sahar}}<br>
{{CMG}}
{{SK}} Nesidioblastoma, IVLM
 
'''Associate Editor-In-Chief:''' {{CZ}}
 
==Overview==
==Overview==
 
Intravenous leiomyomatosis is also refered as IVL. Intravenous leiomyomatosis is characterized by the [[extension]] into [[venous]] channels of [[histologically]] [[Leiomyoma|benign smooth muscle tumor]] arising from either the wall of a [[Vessel wall|vessel]] or from a [[uterine leiomyoma]]. The [[etiology]] of intravenous leiomyomatosis is unclear. Intravenous leiomyomatosis must be [[Differentiate|differentiated]] from other [[diseases]] such as [[Renal cell cancer|renal malignancies]] and [[sarcomas]]. The median age is 45 years, with [[patients]] age ranging from 26 to 70 years old. Only [[females]] may develop intravenous leiomyomatosis. Findings on [[CT scan]] [[diagnostic]] of intravenous leiomyomatosis include an irregular [[mass]] exhibiting [[heterogeneous]] enhancement with [[extension]] into adjacent [[veins]]. Findings on an [[ultrasound]] imaging [[diagnostic]] of intravenous Leiomyomatosis include a vascularized [[thrombi]] within the [[pelvic]] [[Vein|veins]] and [[Inferior vena  cava]]. Findings on [[MRI]] [[diagnostic]] of intravenous leiomyomatosis include a leiomyomatous [[lesion]] or a distorted [[uterus]] with projections into [[vasculature]]. [[Surgery]] is the mainstay of therapy for intravenous leiomyomatosis. It can grow into [[lymphatics]] /[[veins]].
*Intravenous leiomyomatosis (IVLM) is characterized by the extension into venous channels of histologically benign smooth muscle tumor arising from either the wall of a vessel or from a [[uterine leiomyoma]].  
==Historical Perspective==
*Fewer than 100 cases have been reported in all, and only 14 cases involved intracardiac extension from the IVC.  
*Intravenous leiomyomatosis first described in 1896 by German [[Pathologist]] Birch-Hirschfeld.<ref name="pmid11904348">{{cite journal| author=Quade BJ, Dal Cin P, Neskey DM, Weremowicz S, Morton CC| title=Intravenous leiomyomatosis: molecular and cytogenetic analysis of a case. | journal=Mod Pathol | year= 2002 | volume= 15 | issue= 3 | pages= 351-6 | pmid=11904348 | doi=10.1038/modpathol.3880529 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11904348  }}</ref>
*In one reported case, this slowly growing invasive neoplasm extended not only into the heart but into both pulmonary arteries as well. <ref>DJ Kaszar-Seibert, GP Gauvin, PA Rogoff, FJ Vittimberga, S Margolis, AD Hilgenberg, DK Saal, and GO Goldsmith. [http://radiology.rsnajnls.org/cgi/content/abstract/168/2/409 Intracardiac extension of intravenous leiomyomatosis.] Radiology 1988 168: 409-410.</ref>
*First case of leiomyo-matosis of [[pelvic]] origin with [[intravascular]] [[extension]] to [[cardiac]] cavities was described in 1907 in Germany by Dürck and Hörmann.<ref name="pmid10788838">{{cite journal |vauthors=Stolf NA, dos Santos GG, Haddad VL |title=Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection |journal=Rev Hosp Clin Fac Med Sao Paulo |volume=54 |issue=5 |pages=159–64 |date=1999 |pmid=10788838 |doi= |url=}}</ref>
 
==Classification==
* There is no established system for the [[classification]] of intravenous leiomyomatosis.
==Pathophysiology==
==Pathophysiology==
*The etiology of IVLM is unclear. All described patients are female, and most are white, premenopausal, and parous.
*Intravenous leiomyomatosis is characterized by the [[extension]] into [[venous]] channels of [[histologically]] [[Leiomyoma|benign smooth muscle tumors]] arising from either the wall of a [[vessel]] or from a [[uterine leiomyoma]].<ref name="pmid240274072">{{cite journal| author=Mariyappa N, Manikyam UK, Krishnamurthy D, Preeti K, Agarwal Y, Prakar U| title=Intravenous leiomyomatosis. | journal=Niger J Surg | year= 2012 | volume= 18 | issue= 2 | pages= 105-6 | pmid=24027407 | doi=10.4103/1117-6806.103122 | pmc=3762011 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24027407  }}</ref>
*The median age is 45 years, with patients ranging from 26 to 70 years old.
*Approximately 40% of leiomyomata have [[Cytogenetics|cytogenetic]] abnormalities.
*The patients may be asymptomatic or have symptoms of uterine leiomyomas.  
*They are [[Tumor|benign tumors]] of [[uterus]] that extend to [[Veins|venous system]] but do not invade the surrounding [[tissues]]. <ref name="pmid12508249">{{cite journal| author=Dal Cin P, Quade BJ, Neskey DM, Kleinman MS, Weremowicz S, Morton CC| title=Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24). | journal=Genes Chromosomes Cancer | year= 2003 | volume= 36 | issue= 2 | pages= 205-6 | pmid=12508249 | doi=10.1002/gcc.10159 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12508249  }}</ref>
*Patients with obstruction of the right atrium may present with syncopal episodes, dyspnea on exertion, shortness of breath, etc.  
*They contains receptors responsive to [[estrogen]] and [[progesterone]] and hence response to these [[hormones]]. <ref name="pmid125082492">{{cite journal| author=Dal Cin P, Quade BJ, Neskey DM, Kleinman MS, Weremowicz S, Morton CC| title=Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24). | journal=Genes Chromosomes Cancer | year= 2003 | volume= 36 | issue= 2 | pages= 205-6 | pmid=12508249 | doi=10.1002/gcc.10159 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12508249  }}</ref>
*The tumor is slow growing, and the prognosis is favorable.  
*It is also referred as quasi-malignant behavior due to its speedy spreading behavior.<ref name="pmid119043482">{{cite journal| author=Quade BJ, Dal Cin P, Neskey DM, Weremowicz S, Morton CC| title=Intravenous leiomyomatosis: molecular and cytogenetic analysis of a case. | journal=Mod Pathol | year= 2002 | volume= 15 | issue= 3 | pages= 351-6 | pmid=11904348 | doi=10.1038/modpathol.3880529 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11904348  }}</ref>
 
*On [[microscopy]] it is seen as [[benign]], well-differentiated [[tumor]] with [[smooth muscle cell]] growing within [[veins]] as worm-like projections.
*[[Tumor cell|Tumor cells]] shows bizarre [[nuclear]] [[morphology]] with hyperchromatic multilobated [[nuclei]].
*The [[mitotic]] activity is low, with [[mitotic]] index of less than 1 per 50 high-power fields.
==Causes==
* The etiology of intravenous leiomyomatosis is unclear.<ref name="FasihPrasad Shanbhogue2008">{{cite journal|last1=Fasih|first1=Najla|last2=Prasad Shanbhogue|first2=Alampady K.|last3=Macdonald|first3=David B.|last4=Fraser-Hill|first4=Margaret A.|last5=Papadatos|first5=Demetrios|last6=Kielar|first6=Ania Z.|last7=Doherty|first7=Geoffrey P.|last8=Walsh|first8=Cynthia|last9=McInnes|first9=Matthew|last10=Atri|first10=Mostafa|title=Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations|journal=RadioGraphics|volume=28|issue=7|year=2008|pages=1931–1948|issn=0271-5333|doi=10.1148/rg.287085095}}</ref>
==Differentiating Intravenous Leiomyomatosis from other Diseases==
==Differentiating Intravenous Leiomyomatosis from other Diseases==
*When the IVC is involved the differential diagnosis should include renal malignancies and primary leiomyoma or sarcoma, as well as thrombosis of the IVC.  
*Intravenous leiomyomatosis must be [[Differentiate|differentiated]] from other [[conditions]] such as [[intravenous]] [[thrombus]], [[leiomyosarcoma]], right atrial [[myxoma]] and [[thrombosis]] of carcinomas, for example, [[renal cell carcinoma]], [[hepatocellular carcinoma]], and [[adrenocortical carcinoma]].<ref name="LeeKim2011">{{cite journal|last1=Lee|first1=Sak|last2=Kim|first2=Do-Kyun|last3=Narm|first3=Kyoung Shik|last4=Cho|first4=Sang-Ho|title=Pulmonary Artery Embolization of Intravenous Leiomyomatosis Extending into the Right Atrium|journal=The Korean Journal of Thoracic and Cardiovascular Surgery|volume=44|issue=3|year=2011|pages=243–246|issn=2233-601X|doi=10.5090/kjtcs.2011.44.3.243}}</ref><ref name="FasihPrasad Shanbhogue2008">{{cite journal|last1=Fasih|first1=Najla|last2=Prasad Shanbhogue|first2=Alampady K.|last3=Macdonald|first3=David B.|last4=Fraser-Hill|first4=Margaret A.|last5=Papadatos|first5=Demetrios|last6=Kielar|first6=Ania Z.|last7=Doherty|first7=Geoffrey P.|last8=Walsh|first8=Cynthia|last9=McInnes|first9=Matthew|last10=Atri|first10=Mostafa|title=Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations|journal=RadioGraphics|volume=28|issue=7|year=2008|pages=1931–1948|issn=0271-5333|doi=10.1148/rg.287085095}}</ref>
*IVLM should be considered in young women with cardiac symptoms who have a right atrial mass as well as a pelvic mass or who have previously undergone hysterectomy for leiomyoma uterus with intravenous involvement.
*For more information on intravenous leiomyomatosis [[differential diagnosis]], please [[Leiomyosarcoma differential diagnosis|click here]].
 
==Epidemiology and Demographics==
==Complications==
*There is no available data on the exact [[incidence]] of intravenous leiomyomatosis.
*Although embolization of the tumor represents a theoretical risk, this has not been reported.
*The median age at the time of [[diagnosis]]  of IVL is 45 years, with [[patients]] age ranging from 26 to 70 years old. <ref name="pmid7850080">{{cite journal| author=Canzonieri V, D'Amore ES, Bartoloni G, Piazza M, Blandamura S, Carbone A| title=Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis. | journal=Virchows Arch | year= 1994 | volume= 425 | issue= 5 | pages= 541-5 | pmid=7850080 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7850080  }}</ref>
*The tumor can recur, and repeat operation may be necessary.
*Female are exclusively  affected with intravenous leiomyomatosis.<ref name="pmid18312983">{{cite journal| author=Poliquin V, Victory R, Vilos GA| title=Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report. | journal=J Minim Invasive Gynecol | year= 2008 | volume= 15 | issue= 2 | pages= 152-60 | pmid=18312983 | doi=10.1016/j.jmig.2007.12.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18312983  }}</ref>
*Most reported deaths involved extension of the tumor into the heart, with death due to mechanical obstruction rather than the neoplastic process per se
*Intravenous leiomyomatosis is seen more commonly in white [[females]].<ref name="pmid183129832">{{cite journal| author=Poliquin V, Victory R, Vilos GA| title=Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report. | journal=J Minim Invasive Gynecol | year= 2008 | volume= 15 | issue= 2 | pages= 152-60 | pmid=18312983 | doi=10.1016/j.jmig.2007.12.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18312983  }}</ref>
 
==Risk Factors==
*Intravenous leiomyomatosis should not be confused with benign metastasizing leiomyoma, in which a benign uterine leiomyoma is associated with a benign smooth muscle tumor located in the parenchyma of a distant organ, such as lung.  
*Common [[risk factors]] in the development of intravenous leiomyomatosis are [[age]], [[cytogenetic]] abnormalities , and prior history of [[uterine leiomyoma]], and/or [[hysterectomy]].<ref name="LeitmanKuperstein2008">{{cite journal|last1=Leitman|first1=M.|last2=Kuperstein|first2=R.|last3=Medalion|first3=B.|last4=Stamler|first4=A.|last5=Porat|first5=E.|last6=Rosenblatt|first6=S.|last7=Konen|first7=E.|last8=Krakover|first8=R.|last9=Vered|first9=Z.|title=A highly unusual right atrial mass presented in two women|journal=European Heart Journal - Cardiovascular Imaging|volume=9|issue=6|year=2008|pages=833–834|issn=2047-2412|doi=10.1093/ejechocard/jen173}}</ref>
*Intravenous leiomyomatosis is confined to vessels, whereas benign metastasizing leiomyoma shows no relation to vascular channels.
==Screening==
 
*There is insufficient evidence to recommend routine [[screening]] for intravenous leiomyomatosis.
==Images==
== Natural History, Complications and Prognosis==
 
*If left untreated, [[patients]] with intravenous leiomyomatosis may progress to develop [[congestive heart failure]], [[venous]] obstruction, and sudden death.<ref name="pmid284149953">{{cite journal| author=Schäfer HM, Isaak A, Gürke L| title=Case report of an intracaval leiomyomatosis 10 months after complete hysterectomy. | journal=Int J Surg Case Rep | year= 2017 | volume= 35 | issue=  | pages= 1-3 | pmid=28414995 | doi=10.1016/j.ijscr.2017.03.031 | pmc=5394212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28414995  }}</ref><ref name="FasihPrasad Shanbhogue2008">{{cite journal|last1=Fasih|first1=Najla|last2=Prasad Shanbhogue|first2=Alampady K.|last3=Macdonald|first3=David B.|last4=Fraser-Hill|first4=Margaret A.|last5=Papadatos|first5=Demetrios|last6=Kielar|first6=Ania Z.|last7=Doherty|first7=Geoffrey P.|last8=Walsh|first8=Cynthia|last9=McInnes|first9=Matthew|last10=Atri|first10=Mostafa|title=Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations|journal=RadioGraphics|volume=28|issue=7|year=2008|pages=1931–1948|issn=0271-5333|doi=10.1148/rg.287085095}}</ref><ref name="KocicaVranes2005">{{cite journal|last1=Kocica|first1=Mladen J.|last2=Vranes|first2=Mile R.|last3=Kostic|first3=Dusan|last4=Kostic|first4=Natasa Kovacevic-|last5=Lackovic|first5=Vesna|last6=Mihajlovic|first6=Vesna Bozic-|last7=Velinovic|first7=Milos M.|last8=Mikic|first8=Aleksandar Dj.|last9=Kalezic|first9=Nevena Dimitrijevic-|title=Intravenous leiomyomatosis with extension to the heart: Rare or underestimated?|journal=The Journal of Thoracic and Cardiovascular Surgery|volume=130|issue=6|year=2005|pages=1724–1726|issn=00225223|doi=10.1016/j.jtcvs.2005.08.021}}</ref>
===Example #1===
*Other possible [[complications]] of intravenous leiomyomatosis include [[tumor]] recurrence, and [[metastasis]].<ref name="pmid7465135">{{cite journal |vauthors=Evans AT, Symmonds RE, Gaffey TA |title=Recurrent pelvic intravenous leiomyomatosis |journal=Obstet Gynecol |volume=57 |issue=2 |pages=260–4 |date=February 1981 |pmid=7465135 |doi= |url=}}</ref><ref name="AwonugaRotas2008">{{cite journal|last1=Awonuga|first1=Awoniyi O.|last2=Rotas|first2=Michael|last3=Imudia|first3=Anthony N.|last4=Choi|first4=Christine|last5=Khulpateea|first5=Neekianund|title=Recurrent benign metastasizing leiomyoma after hysterectomy and bilateral salpingo-oophorectomy|journal=Archives of Gynecology and Obstetrics|volume=278|issue=4|year=2008|pages=373–376|issn=0932-0067|doi=10.1007/s00404-008-0581-z}}</ref>
 
*[[Prognosis]] is generally good.
Patient presented with S.O.B. one year after hysterectomy for a leiomyomatous uterus (Images shown below are courtesy of RadsWiki and copylefted}
== Diagnosis ==
 
===Diagnostic Criteria===
<div align="left">
*There is no specific [[diagnostic]] Criteria for intravenous leiomyomatosis.
<gallery heights="175" widths="175">
*[[Diagnosis]] may be challenging. However, a history of  A history of [[hysterectomy]] or the presence of [[Uterine leiomyoma|uterine leiomyomas]] may be helpful.<ref name="FasihPrasad Shanbhogue2008">{{cite journal|last1=Fasih|first1=Najla|last2=Prasad Shanbhogue|first2=Alampady K.|last3=Macdonald|first3=David B.|last4=Fraser-Hill|first4=Margaret A.|last5=Papadatos|first5=Demetrios|last6=Kielar|first6=Ania Z.|last7=Doherty|first7=Geoffrey P.|last8=Walsh|first8=Cynthia|last9=McInnes|first9=Matthew|last10=Atri|first10=Mostafa|title=Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations|journal=RadioGraphics|volume=28|issue=7|year=2008|pages=1931–1948|issn=0271-5333|doi=10.1148/rg.287085095}}</ref>
Image:Intravascular-extension-leiomyoma-001.jpg|CT in Intravenous leiomyomatosis
=== History and Symptoms ===
Image:Intravascular-extension-leiomyoma-002.jpg
*[[Patients]] may be asymptomatic or have [[symptoms]] related to [[Uterine leiomyoma|uterine leiomyomas]].<ref name="pmid7820530">{{cite journal| author=Nakayama Y, Kitamura S, Kawachi K, Kawata T, Fukutomi M, Hasegawa J et al.| title=Intravenous leiomyomatosis extending into the right atrium. | journal=Cardiovasc Surg | year= 1994 | volume= 2 | issue= 5 | pages= 642-5 | pmid=7820530 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7820530  }}</ref><ref name="pmid15985146">{{cite journal| author=Moorjani N, Kuo J, Ashley S, Hughes G| title=Intravenous uterine leiomyosarcomatosis with intracardial extension. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 4 | pages= 382-5 | pmid=15985146 | doi=10.1111/j.1540-8191.2005.200476.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15985146  }}</ref><ref name="pmid183129833">{{cite journal| author=Poliquin V, Victory R, Vilos GA| title=Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report. | journal=J Minim Invasive Gynecol | year= 2008 | volume= 15 | issue= 2 | pages= 152-60 | pmid=18312983 | doi=10.1016/j.jmig.2007.12.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18312983  }}</ref>
</gallery>
*[[Symptoms]] related to [[uterine]] [[leiomyoma]] may include [[abdominal pain]], [[abnormal uterine bleeding]], and [[abdominal distension]].<ref name="pmid19423058">{{cite journal |vauthors=Vaquero ME, Magrina JF, Leslie KO |title=Uterine smooth-muscle tumors with unusual growth patterns |journal=J Minim Invasive Gynecol |volume=16 |issue=3 |pages=263–8 |date=2009 |pmid=19423058 |doi=10.1016/j.jmig.2009.01.013 |url=}}</ref>
</div>
*[[Symptoms]] of intravenous Leiomyomatosis due to extension to great [[veins]] or invoving the [[heart]] may include [[dyspnoea]], [[loss of consciousness]], lower extremity [[edema]], [[chest pain]], [[abdominal pain]], and [[fatigue]].
 
=== Physical Examination ===
 
*Patients with  intravenous Leiomyomatosis usually depends on location and [[extension]] of the [[tumor]] which may include [[jugular venous distention]], increased pulse rate, shifting dullness in [[abdominal exam]] suggestive of [[ascites]], and [[lower extremity edema]].<ref name="pmid9555121">{{cite journal |vauthors=Andrade LA, Torresan RZ, Sales JF, Vicentini R, De Souza GA |title=Intravenous leiomyomatosis of the uterus. A report of three cases |journal=Pathol. Oncol. Res. |volume=4 |issue=1 |pages=44–7 |date=1998 |pmid=9555121 |doi= |url=}}</ref>
<div align="left">
=== Laboratory Findings ===
<gallery heights="175" widths="175">
*There are no specific laboratory findings associated with intravenous Leiomyomatosis.
Image:Intravascular-extension-leiomyoma-003.jpg
=== Electrocardiogram ===
Image:Intravascular-extension-leiomyoma-004.jpg
*There are no [[ECG]] findings associated with intravenous Leiomyomatosis.
</gallery>
=== X-ray ===
</div>
*There are no [[x-ray]] findings associated with intravenous Leiomyomatosis.
 
=== Echocardiography or Ultrasound ===
 
*[[Echocardiography]]/[[ultrasound]] may be helpful in the [[diagnosis]] of intravenous Leiomyomatosis.
<div align="left">
*Findings on an [[ultrasound]] imaging [[diagnostic]] of intravenous Leiomyomatosis include a [[vascularized]] [[thrombi]] within the [[pelvic]] [[veins]] and [[IVC]].<ref name="FasihPrasad Shanbhogue2008">{{cite journal|last1=Fasih|first1=Najla|last2=Prasad Shanbhogue|first2=Alampady K.|last3=Macdonald|first3=David B.|last4=Fraser-Hill|first4=Margaret A.|last5=Papadatos|first5=Demetrios|last6=Kielar|first6=Ania Z.|last7=Doherty|first7=Geoffrey P.|last8=Walsh|first8=Cynthia|last9=McInnes|first9=Matthew|last10=Atri|first10=Mostafa|title=Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations|journal=RadioGraphics|volume=28|issue=7|year=2008|pages=1931–1948|issn=0271-5333|doi=10.1148/rg.287085095}}</ref>
<gallery heights="175" widths="175">
*[[Echocardiography]] may show findings consistent with [[right atrial]] involvement of the [[tumor]].
Image:Intravascular-extension-leiomyoma-005.jpg
*Possible findings of IVL on [[echocardiography]] include hyperechoic elongated mobile [[mass]] extending from the [[inferior vena cava]] and an irregular [[lesion]] in the [[right atrium]] and sometimes with protrusion into the [[right ventricle]].<ref name="pmid22340462">{{cite journal |vauthors=Kang LQ, Zhang B, Liu BG, Liu FH |title=Diagnosis of intravenous leiomyomatosis extending to heart with emphasis on magnetic resonance imaging |journal=Chin. Med. J. |volume=125 |issue=1 |pages=33–7 |date=January 2012 |pmid=22340462 |doi= |url=}}</ref>
Image:Intravascular-extension-leiomyoma-006.jpg
=== CT scan ===
</gallery>
*[[Pelvic]] [[CT scan]] may be helpful in the [[diagnosis]] of intravenous leiomyomatosis.<ref name="Xu2013">{{cite journal|last1=Xu|first1=Zhi-Feng|title=Uterine intravenous leiomyomatosis with cardiac extension: Imaging characteristics and literature review|journal=World Journal of Clinical Oncology|volume=4|issue=1|year=2013|pages=25|issn=2218-4333|doi=10.5306/wjco.v4.i1.25}}</ref>
</div>
*Findings on [[CT scan]] [[diagnostic]] of intravenous leiomyomatosis include an irregular [[mass]] exhibiting [[heterogeneous]] enhancement with [[extension]] into adjacent [[veins]].
 
=== MRI ===
 
*[[Pelvic]] [[MRI]] may be helpful in the [[diagnosis]] of intravenous leiomyomatosis.<ref name="FasihPrasad Shanbhogue2008">{{cite journal|last1=Fasih|first1=Najla|last2=Prasad Shanbhogue|first2=Alampady K.|last3=Macdonald|first3=David B.|last4=Fraser-Hill|first4=Margaret A.|last5=Papadatos|first5=Demetrios|last6=Kielar|first6=Ania Z.|last7=Doherty|first7=Geoffrey P.|last8=Walsh|first8=Cynthia|last9=McInnes|first9=Matthew|last10=Atri|first10=Mostafa|title=Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations|journal=RadioGraphics|volume=28|issue=7|year=2008|pages=1931–1948|issn=0271-5333|doi=10.1148/rg.287085095}}</ref>
<div align="left">
*Findings on [[MRI]] [[diagnostic]] of intravenous leiomyomatosis include a leiomyomatous [[lesion]] or a distorted [[uterus]] with projections into [[vasculature]].
<gallery heights="175" widths="175">
*The [[tumor]] usually shows low signal intensity similar to that of [[smooth muscle]] on T2-weighted images and low to intermediate signal intensity on T1-weighted images.
Image:Intravascular-extension-leiomyoma-007.jpg
*The appearance of the [[lesion]] varies according to its [[smooth muscle cell]] and [[fibrous]] [[tissue]] content.
Image:Intravascular-extension-leiomyoma-008.jpg
===Other Imaging Findings===
</gallery>
*There are no other [[imaging]] findings associated with intravenous leiomyomatosis.
</div>
===Other Diagnostic Studies===
 
*There are no other [[diagnostic]] studies associated with intravenous leiomyomatosis.
==See Also==
== Treatment ==
*[[Uterine leiomyoma]]
=== Medical Therapy ===
*Benign metastasizing leiomyoma
*There is no treatment for intravenous leiomyomatosis.
 
=== Surgery ===
==External Links==
*[[Surgery]] is the treatment of choice, and complete removal of the [[tumor]] is mandatory.
*[http://goldminer.arrs.org/search.php?query=Intravenous%20leiomyomatosis Goldminer: Intravenous leiomyomatosis]
*Recurrences may occur up to 15 years after the primary occurrence in [[patients]] with Incomplete resection of the [[tumor]].<ref name="pmid25743551">{{cite journal| author=Yanagiya A, Yamada O, Nanbu T, Hamada H, Takada J, Matsuura M et al.| title=[One-stage resection of intravenous leiomyomatosis extending into the right atrium]. | journal=Kyobu Geka | year= 2015 | volume= 68 | issue= 3 | pages= 188-91 | pmid=25743551 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25743551  }}</ref>
 
*[[Bilateral]] [[oophorectomy]] causes shutdown of hormonal stimulation hence helps preventing recurrence.<ref name="pmid16583249">{{cite journal| author=Castelli P, Caronno R, Piffaretti G, Tozzi M| title=Intravenous uterine leiomyomatosis with right heart extension: successful two-stage surgical removal. | journal=Ann Vasc Surg | year= 2006 | volume= 20 | issue= 3 | pages= 405-7 | pmid=16583249 | doi=10.1007/s10016-006-9024-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16583249  }}</ref>
*[[Surgical]] removal can be done in single or staged procedures.<ref name="pmid12694674">{{cite journal| author=Nam MS, Jeon MJ, Kim YT, Kim JW, Park KH, Hong YS| title=Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature. | journal=Gynecol Oncol | year= 2003 | volume= 89 | issue= 1 | pages= 175-80 | pmid=12694674 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12694674  }}</ref>
=== Primary Prevention ===
*There are no [[Primary prevention|primary preventive]] measures available for IVL.
=== Secondary Prevention ===
*There are no [[Secondary prevention|secondary preventive]] measures available for IVL.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 13:31, 26 November 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Template:Sonia Sandeep Js Sahar Memar Montazerin, M.D.[2]
Synonyms and keywords: Nesidioblastoma, IVLM

Overview

Intravenous leiomyomatosis is also refered as IVL. Intravenous leiomyomatosis is characterized by the extension into venous channels of histologically benign smooth muscle tumor arising from either the wall of a vessel or from a uterine leiomyoma. The etiology of intravenous leiomyomatosis is unclear. Intravenous leiomyomatosis must be differentiated from other diseases such as renal malignancies and sarcomas. The median age is 45 years, with patients age ranging from 26 to 70 years old. Only females may develop intravenous leiomyomatosis. Findings on CT scan diagnostic of intravenous leiomyomatosis include an irregular mass exhibiting heterogeneous enhancement with extension into adjacent veins. Findings on an ultrasound imaging diagnostic of intravenous Leiomyomatosis include a vascularized thrombi within the pelvic veins and Inferior vena cava. Findings on MRI diagnostic of intravenous leiomyomatosis include a leiomyomatous lesion or a distorted uterus with projections into vasculature. Surgery is the mainstay of therapy for intravenous leiomyomatosis. It can grow into lymphatics /veins.

Historical Perspective

Classification

  • There is no established system for the classification of intravenous leiomyomatosis.

Pathophysiology

Causes

  • The etiology of intravenous leiomyomatosis is unclear.[7]

Differentiating Intravenous Leiomyomatosis from other Diseases

Epidemiology and Demographics

  • There is no available data on the exact incidence of intravenous leiomyomatosis.
  • The median age at the time of diagnosis of IVL is 45 years, with patients age ranging from 26 to 70 years old. [9]
  • Female are exclusively affected with intravenous leiomyomatosis.[10]
  • Intravenous leiomyomatosis is seen more commonly in white females.[11]

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for intravenous leiomyomatosis.

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

  • There are no specific laboratory findings associated with intravenous Leiomyomatosis.

Electrocardiogram

  • There are no ECG findings associated with intravenous Leiomyomatosis.

X-ray

  • There are no x-ray findings associated with intravenous Leiomyomatosis.

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

  • There are no other imaging findings associated with intravenous leiomyomatosis.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with intravenous leiomyomatosis.

Treatment

Medical Therapy

  • There is no treatment for intravenous leiomyomatosis.

Surgery

  • Surgery is the treatment of choice, and complete removal of the tumor is mandatory.
  • Recurrences may occur up to 15 years after the primary occurrence in patients with Incomplete resection of the tumor.[24]
  • Bilateral oophorectomy causes shutdown of hormonal stimulation hence helps preventing recurrence.[25]
  • Surgical removal can be done in single or staged procedures.[26]

Primary Prevention

Secondary Prevention

References

  1. ↑ Quade BJ, Dal Cin P, Neskey DM, Weremowicz S, Morton CC (2002). "Intravenous leiomyomatosis: molecular and cytogenetic analysis of a case". Mod Pathol. 15 (3): 351–6. doi:10.1038/modpathol.3880529. PMID 11904348.
  2. ↑ Stolf NA, dos Santos GG, Haddad VL (1999). "Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection". Rev Hosp Clin Fac Med Sao Paulo. 54 (5): 159–64. PMID 10788838.
  3. ↑ Mariyappa N, Manikyam UK, Krishnamurthy D, Preeti K, Agarwal Y, Prakar U (2012). "Intravenous leiomyomatosis". Niger J Surg. 18 (2): 105–6. doi:10.4103/1117-6806.103122. PMC 3762011. PMID 24027407.
  4. ↑ Dal Cin P, Quade BJ, Neskey DM, Kleinman MS, Weremowicz S, Morton CC (2003). "Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24)". Genes Chromosomes Cancer. 36 (2): 205–6. doi:10.1002/gcc.10159. PMID 12508249.
  5. ↑ Dal Cin P, Quade BJ, Neskey DM, Kleinman MS, Weremowicz S, Morton CC (2003). "Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24)". Genes Chromosomes Cancer. 36 (2): 205–6. doi:10.1002/gcc.10159. PMID 12508249.
  6. ↑ Quade BJ, Dal Cin P, Neskey DM, Weremowicz S, Morton CC (2002). "Intravenous leiomyomatosis: molecular and cytogenetic analysis of a case". Mod Pathol. 15 (3): 351–6. doi:10.1038/modpathol.3880529. PMID 11904348.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Fasih, Najla; Prasad Shanbhogue, Alampady K.; Macdonald, David B.; Fraser-Hill, Margaret A.; Papadatos, Demetrios; Kielar, Ania Z.; Doherty, Geoffrey P.; Walsh, Cynthia; McInnes, Matthew; Atri, Mostafa (2008). "Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations". RadioGraphics. 28 (7): 1931–1948. doi:10.1148/rg.287085095. ISSN 0271-5333.
  8. ↑ Lee, Sak; Kim, Do-Kyun; Narm, Kyoung Shik; Cho, Sang-Ho (2011). "Pulmonary Artery Embolization of Intravenous Leiomyomatosis Extending into the Right Atrium". The Korean Journal of Thoracic and Cardiovascular Surgery. 44 (3): 243–246. doi:10.5090/kjtcs.2011.44.3.243. ISSN 2233-601X.
  9. ↑ Canzonieri V, D'Amore ES, Bartoloni G, Piazza M, Blandamura S, Carbone A (1994). "Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis". Virchows Arch. 425 (5): 541–5. PMID 7850080.
  10. ↑ Poliquin V, Victory R, Vilos GA (2008). "Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report". J Minim Invasive Gynecol. 15 (2): 152–60. doi:10.1016/j.jmig.2007.12.009. PMID 18312983.
  11. ↑ Poliquin V, Victory R, Vilos GA (2008). "Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report". J Minim Invasive Gynecol. 15 (2): 152–60. doi:10.1016/j.jmig.2007.12.009. PMID 18312983.
  12. ↑ Leitman, M.; Kuperstein, R.; Medalion, B.; Stamler, A.; Porat, E.; Rosenblatt, S.; Konen, E.; Krakover, R.; Vered, Z. (2008). "A highly unusual right atrial mass presented in two women". European Heart Journal - Cardiovascular Imaging. 9 (6): 833–834. doi:10.1093/ejechocard/jen173. ISSN 2047-2412.
  13. ↑ Schäfer HM, Isaak A, Gürke L (2017). "Case report of an intracaval leiomyomatosis 10 months after complete hysterectomy". Int J Surg Case Rep. 35: 1–3. doi:10.1016/j.ijscr.2017.03.031. PMC 5394212. PMID 28414995.
  14. ↑ Kocica, Mladen J.; Vranes, Mile R.; Kostic, Dusan; Kostic, Natasa Kovacevic-; Lackovic, Vesna; Mihajlovic, Vesna Bozic-; Velinovic, Milos M.; Mikic, Aleksandar Dj.; Kalezic, Nevena Dimitrijevic- (2005). "Intravenous leiomyomatosis with extension to the heart: Rare or underestimated?". The Journal of Thoracic and Cardiovascular Surgery. 130 (6): 1724–1726. doi:10.1016/j.jtcvs.2005.08.021. ISSN 0022-5223.
  15. ↑ Evans AT, Symmonds RE, Gaffey TA (February 1981). "Recurrent pelvic intravenous leiomyomatosis". Obstet Gynecol. 57 (2): 260–4. PMID 7465135.
  16. ↑ Awonuga, Awoniyi O.; Rotas, Michael; Imudia, Anthony N.; Choi, Christine; Khulpateea, Neekianund (2008). "Recurrent benign metastasizing leiomyoma after hysterectomy and bilateral salpingo-oophorectomy". Archives of Gynecology and Obstetrics. 278 (4): 373–376. doi:10.1007/s00404-008-0581-z. ISSN 0932-0067.
  17. ↑ Nakayama Y, Kitamura S, Kawachi K, Kawata T, Fukutomi M, Hasegawa J; et al. (1994). "Intravenous leiomyomatosis extending into the right atrium". Cardiovasc Surg. 2 (5): 642–5. PMID 7820530.
  18. ↑ Moorjani N, Kuo J, Ashley S, Hughes G (2005). "Intravenous uterine leiomyosarcomatosis with intracardial extension". J Card Surg. 20 (4): 382–5. doi:10.1111/j.1540-8191.2005.200476.x. PMID 15985146.
  19. ↑ Poliquin V, Victory R, Vilos GA (2008). "Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report". J Minim Invasive Gynecol. 15 (2): 152–60. doi:10.1016/j.jmig.2007.12.009. PMID 18312983.
  20. ↑ Vaquero ME, Magrina JF, Leslie KO (2009). "Uterine smooth-muscle tumors with unusual growth patterns". J Minim Invasive Gynecol. 16 (3): 263–8. doi:10.1016/j.jmig.2009.01.013. PMID 19423058.
  21. ↑ Andrade LA, Torresan RZ, Sales JF, Vicentini R, De Souza GA (1998). "Intravenous leiomyomatosis of the uterus. A report of three cases". Pathol. Oncol. Res. 4 (1): 44–7. PMID 9555121.
  22. ↑ Kang LQ, Zhang B, Liu BG, Liu FH (January 2012). "Diagnosis of intravenous leiomyomatosis extending to heart with emphasis on magnetic resonance imaging". Chin. Med. J. 125 (1): 33–7. PMID 22340462.
  23. ↑ Xu, Zhi-Feng (2013). "Uterine intravenous leiomyomatosis with cardiac extension: Imaging characteristics and literature review". World Journal of Clinical Oncology. 4 (1): 25. doi:10.5306/wjco.v4.i1.25. ISSN 2218-4333.
  24. ↑ Yanagiya A, Yamada O, Nanbu T, Hamada H, Takada J, Matsuura M; et al. (2015). "[One-stage resection of intravenous leiomyomatosis extending into the right atrium]". Kyobu Geka. 68 (3): 188–91. PMID 25743551.
  25. ↑ Castelli P, Caronno R, Piffaretti G, Tozzi M (2006). "Intravenous uterine leiomyomatosis with right heart extension: successful two-stage surgical removal". Ann Vasc Surg. 20 (3): 405–7. doi:10.1007/s10016-006-9024-0. PMID 16583249.
  26. ↑ Nam MS, Jeon MJ, Kim YT, Kim JW, Park KH, Hong YS (2003). "Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature". Gynecol Oncol. 89 (1): 175–80. PMID 12694674.

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