title: Management of intravenous leiomyomatosis with intracaval and intracardiac extension.
abstract: OBJECTIVE
  To report the results of management of intravenous leiomyomatosis with intracaval and intracardiac extension at Peking Union Medial College Hospital.
  
  
  METHODS
  We reviewed a cohort of 20 patients with intravenous leiomyomatosis extending to the inferior vena cava and heart, focusing on the clinical characteristics, the results of surgical management, and prognosis.
  
  
  RESULTS
  The mean age of the patients was 42.4 ± 7.0 years. The clinical manifestations of intravenous leiomyomatosis are various and nonspecific, including pelvic mass, chest tightness and shortness of breath, swelling in the lower extremity, abdominal distension, palpitation, syncope, hypermenorrhea, and skelalgia. All the patients had history of uterine leiomyoma and 16 patients (80%) had undergone uterine leiomyoma operation. After careful preoperative evaluation, nine patients underwent one-stage operations (cardiac surgery, vascular and gynecologic surgery together) and 11 patients underwent two-stage operations (cardiac surgery first, then vascular and gynecologic surgery). There was no significant difference in the postoperative complication rate (33.3% compared with 27.3%; P>.99) between one-stage and two-stage operations. All operations were performed without severe surgical-related complications or death. Approximately 78% of patients had complete resection of tumor and 22.2% of the patients experienced incomplete resection. Eleven (55%) patients received hormone therapy postoperatively. During mean follow-up time of 20.5 months, recurrence occurred in five patients (27.8%) but all the patients survived.
  
  
  CONCLUSIONS
  Precise and full-scale preoperative evaluation, complete tumor resection, and multidisciplinary cooperation are crucial for successful treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Wang
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Yang
authors.forename: Huifang
authors.initials: H
authors.lastname: Huang
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Qi
authors.initials: Q
authors.lastname: Miao
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Li
authors.forename: Ning
authors.initials: N
authors.lastname: Yang
authors.forename: Yuguang
authors.initials: Y
authors.lastname: Huang
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Dongyan
authors.initials: D
authors.lastname: Cao
authors.forename: Ming
authors.initials: M
authors.lastname: Wu
authors.forename: Lingya
authors.initials: L
authors.lastname: Pan
authors.forename: Jinghe
authors.initials: J
authors.lastname: Lang
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D018231:Leiomyomatosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D008875:Middle Aged; D009383:Neoplasms, Vascular Tissue / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D014684:Venae Cavae / Q000601:surgery*
chemical_list: D018931:Antineoplastic Agents, Hormonal