Uterine intravenous leiomyomatosis with an isolated large metastasis to the right atrium: a case report
Uterine intravenous leiomyomatosis with an isolated large metastasis to the right atrium: a case report
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DOI：
10.1186/s13000-019-0913-2
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发表时间：
2020-01-11
影响因子：
2.6
通讯作者：
Yasuda, Masanori
中科院分区：
文献类型：
--
作者：
Yano, Mitsutake;Katoh, Tomomi;Yasuda, Masanori
静脉内平滑肌瘤病是一种特殊类型的子宫平滑肌瘤，其特征是在血管壁内形成良性平滑肌瘤组织。虽然组织学上是良性的，但如果不治疗，心内转移可导致循环衰竭和死亡。在此，我们报告一例子宫静脉平滑肌瘤病，并在心脏右心房有一个孤立的大粘附转移。病例介绍一名52岁日本女性因下腹部疼痛来我院就诊。临床影像学检查子宫肿块27 cm，术前超声心动图检查右心房肿块78 x 47 mm。心内肿块切除和三尖瓣环成形术作为第一阶段手术。肿瘤蒂附着于心房壁。组织学检查发现肿瘤由梭形细胞组成，胞浆嗜酸性，无异型性，但有黏液样改变，蒂微血管丰富。二期手术行全腹子宫切除术，确诊为子宫静脉平滑肌瘤病伴右心房孤立转移灶。手术后15个月没有肿瘤复发的迹象。结论我们报告了一例独特的病例，在子宫静脉平滑肌瘤病后发现了一个大的右心房平滑肌瘤。我们的病例说明静脉平滑肌瘤转移瘤有可能通过血管化生长。
Background An intravenous leiomyomatosis is a special type of uterine leiomyoma characterized by the formation of benign leiomyomatous tissue within the vascular wall. Although histologically benign, intracardiac metastasis can lead to circulatory failure, and death, if untreated. Herein, we report on a case of a uterine intravenous leiomyomatosis with an isolated large adherent metastasis in the right atrium of the heart. Case Presentation A 52-year-old Japanese woman sought medical attention at our hospital for lower abdominal pain. A 27-cm uterine mass was detected on clinical imaging, with a 78 x 47-mm mass in the right atrium detected on preoperative echocardiography. Intracardiac mass resection and tricuspid annuloplasty were performed as the first-stage surgery. The pedicle of the tumor was adherent to the wall of the atrium. On histological examination, the tumor was found to consist of spindle-shaped cells with eosinophilic cytoplasm, without atypia, but with a myxoid change, and rich microvascularization of the pedicle. Total abdominal hysterectomy was performed as the second-stage surgery, with confirmation of the diagnosis as uterine intravenous leiomyomatosis with an isolated metastasic lesion to the right atrium. There has been no evidence of tumor recurrence in the 15 months since surgery. Conclusion We report a unique case in which a large right atrial leiomyoma was identified following a uterine intravenous leiomyomatosis. Our case exemplifies that intravenous leiomyomatosis metastatic tumors have the potential to grow via their vascularization.