title: Two-stage resection of a disseminated mixed endometrial stromal sarcoma and smooth muscle tumor with intravascular and intracardiac extension.
abstract: OBJECTIVE
  Mixed endometrial stromal and smooth muscle tumor (MESSMT)-a rare mesenchymal uterine tumor of the uterus with atypical clinical symptoms-is susceptible to misdiagnosis and missed diagnosis. We report a case of a disseminated MESSMT with intravenous and intracardiac extensions treated with staging surgery and review previously documented cases of such tumors with intracardiac extension.
  
  
  METHODS
  The case involves a 45-year-old woman with disseminated MESSMT that originated in the uterus and progressed through the iliac vein, inferior vena cava, right atrium, and into the right ventricle, which closely resembled intravenous leiomyomatosis (IVL) grossly and microscopically. She presented with a 1-year history of dyspnea on exertion. IVL was highly suspected preoperatively based on computed tomography and magnetic resonance imaging findings. Two-stage surgeries were performed successfully. The postoperative pathology indicated a disseminated MESSMT.
  
  
  CONCLUSIONS
  This case illustrates the important role of pathology and immunohistochemistry in the differential diagnosis of a rare tumor that mimics the characteristics of IVL with intracardiac involvement and demonstrates the therapeutic strategy for this rare entity.
authors.affiliation: Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
authors.forename: Ai-Qian
authors.initials: AQ
authors.lastname: Zhang
authors.affiliation: Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Xue
authors.affiliation: Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
authors.forename: Dian-Jun
authors.initials: DJ
authors.lastname: Wang
authors.affiliation: Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
authors.forename: Wan-Pin
authors.initials: WP
authors.lastname: Nie
authors.affiliation: Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China. Electronic address: dabaoxu@yahoo.com.
authors.forename: Da-Bao
authors.initials: DB
authors.lastname: Xu
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA. Electronic address: xiaoming@bcm.edu.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Guan
mesh_terms: D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006338:Heart Neoplasms / Q000556:secondary* / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D007084:Iliac Vein / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D018203:Sarcoma, Endometrial Stromal / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D018235:Smooth Muscle Tumor / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D019043:Vascular Neoplasms / Q000556:secondary* / Q000601:surgery; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery
keywords: endometrial stromal sarcoma; intracardiac extension; intravascular extension; smooth muscle tumor