The non-specific symptomatology is correlated with the severity of cardiac involvement. The IVL can be related to the obstructive effect on the tricuspid orifice and disturbance of venous return into the right atrium, which could include pulmonary dyspnea, syncopal episodes, pulmonary embolism and sudden death. Differential diagnosis include atrial mixoma, inferior vena cava thrombosis, abdominal tumors such as hepatocellular carcinoma, renal cell carcinoma, Wilms tumor (typical of children), adrenal tumor, leiomyosarcoma of the uterus and metastatic tumors (10,11).
Atrial mixoma originates from the interatrial septum and extended to the left ventricular cavities; in preoperative step, kidney cancer can distinguished with imaging that can highlights kidney lesion, but in postoperative step, kidney cancer can diagnosed with histological examination. “Imaging” has allowed a correct preoperative diagnosis. Trans-thoracic echocardiography (TTE) can give a “real-time” information on the intra-cardiac lesion, its size and mobility. Trans- esophageal echocardiography (TEE) revealed in a more detailed way a hyperechoic and mobile mass that filled until 2/3 of the right atrium and protruded across the tricuspid valve (12,13). The contrast- enhanced CT and MRI are used to define sites, localization, origin and extent and to give accurate anatomical information (14,15).
Surgery can be performed in one or two stages: resection of intrathoracic and abdominal/pelvic tumor in two separate operations or involving total resection of the tumor (16,17,18,19). It is decided on the basis of the clinical condition of the patient and of the surgical agreements that may change during surgery for the appearance of complications. Surgery with complete excision of the tumor is strongly recommended for a favorable outcome; no recurrent disease has been reported in 15 years follow-up.
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- Cornelis F., Belleannee G., Lederlin M. Cardiac extension of an intravascular leiomyomatosis 43 years after hysterectomy. Thorac Cardiovasc Surg 2012; 144: e3-5.
- Bin Li, Xin Chen, Ya-Dong Chu, Ren-Yuan Li, Wei-Dong Li and Yi-Ming Ni. Intracardiac leiomyiomatosis: a comprehensive analysis of 194 cases. Interactive Cardiovascular and Thoracic Surgery 17 (2013) 132-139
- Cigdem Vural, Ozlem Ozen, Beyhan Demirhan. Intravenous lipoleiomyomatosis of uterus with cardiac extension: a case report. Pathology-Research and practice. Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey, 2010
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- A. Andrade, Intravenous leiomyomatosis of the uterus: a report of three cases, Pathology Oncology Research 4 (1998) 44-47
- Lou at al. Intravenous leiomyomatosis of the uterus with extension to the right heart. Cardiovascular Ultrasound 2011; 9:25
- Durck H. Ueber ien Kontinvierlich durch die entere Holhlvene in des Herz vor Wachsendy: fibromyon des uterus. Munchen Med We-hnschr 1907; 54:1154
- Ines Cruz, Isabel Joao, Bruno Stuart, Mario Iala, Luisa Bento, Carlos Cotrim, Angelo Nobre, Helder Pereira. Intravenous leiomyomatosis: a rare cause of intracardiac mass. Rev Port cardiol 2014; 33(11): 735 e 1-735.e.5
- Leitman M., Kuperstein R, Medalion B, et al. A highly unusual right atrial mass presented in two women. Eur J Echocardiogr. 2008; 9: 8333-834
- Rongjuan Li, Yanguang Shen, Yan Sun, Chuanchen Zhang, Ya Yang, Jiao Yang, Ruijuan Su, Bo Jiang. Intravenous Leiomyomatosis with Intracardiac extension: Echocardiographic Study and Literature Review Surgical Technique
- Yu-Feng Lou, Xin-Ping Shi, Ze-Zhou Song. Intravenous leiomyomatosis of the uterus with extension to the right heart. Cardiovascular Ultrasound 2011, 9; 25
- Hanjiang Zeng, Zhongzi Xu et al. Intravenous leiomyomatosis with intracardiac extension depicted on computed tomography and magnetic resonance imaging scans: a report of two cases and a review of the literature. Oncology letters 11 (2016): 4255-4263
- Zhi-Feng Xu, Fang Yong, Ying-Yu Chen, Ai-Zhen Pan. Uterine intravenous leiomyomatosis with cardiac extension: Imaging characteristic and literature review. World J of Clin Oncol 2013 10; 4(1) 25-28
- Lei Yu et al. Intravenous Leiomyomatosis with intracardiac extension: a report of two cases. J Card Surg 2011; 26:37-68
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- Xihui Li, Feng Xiao, Yinmo Yang, Yindong He and Siyu Zhang. One-stage complete resection of giant intracardiac leiomyomatosis with moderate hypothermia extracorporeal circulation and beating heart technique with 36 months follow-up-a case report. Journal of Cardiothoracic Surgery (2016) 11; 64 10
- Marcia Maria Morales, Alexandre Anacleto, Joao Carlos Leal, Sergio Carvalho, Jeronimo Del’Arco. Intravascular leiomyoma with heart extension. Case report. Clinics 2012; 67 (1):83-87