title: Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography.
abstract: We herein report a case of low-grade endometrial stromal sarcoma with intracardiac extension in a 58-year-old woman with a uterine tumor with intravascular involvement. The tumor was suspected preoperatively to be an endometrial stromal sarcoma by magnetic resonance imaging. The extent of intravascular involvement was determined to be below the level of the renal veins on preoperative contrast-enhanced computed tomography (CT). However, perioperative echography revealed that the tumor extended to the right atrium. An emergency cardiotomy with extracorporeal circulation was required. The risk of tumor embolism was reduced through transection of the inferior vena cava, but the tumor was difficult to remove completely. Postoperative hormonal therapy reduced the size of the residual tumor and no recurrence was detected for 1 year. The preoperative contrast-enhanced CT was unable to detect the free-floating intravascular tumor. This case illustrates a limitation of CT and indicates that accurate determination of the tumor extent for planning a surgical strategy in similar cases should be performed using multiple imaging methods.
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Nogami
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Yamagami
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Maki
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Banno
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Susumu
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Matsubara
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Obara
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Aoki
keywords: contrast-enhanced computed tomography; endometrial stromal sarcoma; intracardiac extension; intravascular leiomyomatosis; tumor thrombosis