Postmenopausal intravenous leiomyomatosis with high levels of estradiol and estrogen receptor.
BACKGROUND
Intravenous leiomyomatosis is a rare variant of leiomyoma.


METHODS
The patient was a 49-year-old gravida 3, para 3 woman with menopause at age 46. She presented with a history of syncope. Vaginal examination revealed an enlarged and elastic-soft mass of the uterus. A pelvic ultrasound, computed tomography scan, and magnetic resonance imaging showed a heterogeneous, irregularly shaped 8- to 10-cm tumor. In addition, the inferior vena cava was almost completely occluded. Cardiac ultrasound demonstrated a mobile mass in the right atrium. The serum estradiol was 208 pg/mL (normal 0-59). Intravenous leiomyomatosis with cardiac extension was diagnosed preoperatively. A resection of the intracardiac and intracaval mass and a subtotal hysterectomy with bilateral salpingo-oophorectomy were performed. The uterine tumor weighed 600 g, and the cordlike intravascular tumor extending from the internal iliac vein into the right ventricle was 40 cm long and weighed 60 g. Pathologic examination confirmed intravenous leiomyomatosis with no evidence of atypia. The level of estrogen receptor in the tissue was 140 fmol/mg protein. The postoperative course was uneventful, and she has been in good health for 17 months after the operation.


CONCLUSIONS
We report a case of intravenous leiomyomatosis extending into the right ventricle treated with a one-stage operation. It is possible that a high concentration of serum estradiol and high level of tissue estrogen receptor are related to the intravenous leiomyomatosis.
Kokawa
Katsuji
K
Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan. katsu@wakayama-med
Yamoto
Mareo
M
Yata
Chie
C
Mabuchi
Yasushi
Y
Umesaki
Naohiko
N
D004958:Estradiol / Q000097:blood; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006338:Heart Neoplasms / Q000473:pathology* / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007084:Iliac Vein / Q000473:pathology; D018231:Leiomyomatosis / Q000097:blood / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009383:Neoplasms, Vascular Tissue / Q000097:blood / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology; D017698:Postmenopause; D011960:Receptors, Estrogen / Q000097:blood; D014594:Uterine Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D014682:Vena Cava, Inferior / Q000473:pathology
D011960:Receptors, Estrogen; D004958:Estradiol