Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein.
OBJECTIVE
To report a conservative surgical management of cardiac-extending intravenous (IV) leiomyomatosis.


METHODS
Case report.


METHODS
Tertiary care center.


METHODS
A 40-year-old nulligravid with incidentally identified IV leiomyomatosis arising from the right gonadal vein and extending into the right atrium.


METHODS
First, intraoperative transesophageal echocardiogram was performed that demonstrated the IV leiomyomatosis stalk to be 1.1 cm in diameter without an enlarged tip or adherence to the vessel lumen. Next, the 20-week-size uterus was gently pulled caudally under live visualization of the IV leiomyomatosis tip with transesophageal echocardiogram. As the uterus was pulled caudally, the IV leiomyomatosis tip obviously protruded from the right atrium and down into inferior vena cava. Lastly, the gonadal vein was incised longitudinally and the stalk of the tumor was grasped and extracted through the incision.


METHODS
One-step abdominal surgery for complete tumor resection without sternotomy or cardiac bypass surgery.


RESULTS
To our knowledge, this is the first reported case of a cardiac-extending IV leiomyomatosis successfully extracted through the gonadal vein.


CONCLUSIONS
In a selected case with logistic step-by-step approach, conservative surgical treatment via gonadal vein extraction could be a feasible option in the management of cardiac-extending IV leiomyomatosis. Systematic literature review highlights important clinical characteristics and management options for IV leiomyomatosis.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, California 90031, USA. koji.matsuo@gmail.com
Koji
K
Matsuo
Fernando
F
Fleischman
Christian S
CS
Ghattas
Anna S
AS
Gabrielyan
Charles A
CA
Ballard
Lynda D
LD
Roman
C Paul
CP
Morrow
D000328:Adult; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D007044:Hysterectomy; D033162:Incidental Findings; D018231:Leiomyomatosis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D010053:Ovary / Q000098:blood supply*; D058994:Salpingectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014680:Veins / Q000473:pathology / Q000601:surgery