Inguinal pain and fullness due to an intravascular leiomyoma in the external iliac vein

Abstract

Intravascular leiomyomatosis (IVL) is a benign smooth muscle tumor that evolves from the pelvic veins and can spread to the central veins and heart. Cardiac involvement is the most commonly reported presentation. Initial diagnosis is difficult, and IVL is commonly misdiagnosed as thrombus or atrial myxoma. Appropriate imaging and a high clinical suspicion are required for accurate diagnosis. We report a rare case of IVL in the external iliac vein that recurred 4 years after hysterectomy. Only four cases have been reported in the literature to involve the external iliac vein as it has no direct connection to pelvic venous drainage.

Fig 1

A, Coronal magnetic resonance venography of pelvis showing a normal right external iliac vein (EIV) and a suspicious mass (arrow) with a filling defect in the left EIV. B, Duplex ultrasound examination of the left EIV with a hypoechoic lesion in the lumen without chronic vessel wall inflammation or fibrosis (arrow).

Fig 2

Gross specimen of an intravascular leiomyoma from the external iliac vein (EIV) extending from a collateral vein (identified by surgical clips). The smooth nodular appearance is typical of intravascular leiomyomatosis (IVL).

Fig 3

A, Proliferation of benign-appearing smooth muscle cells found within the external iliac vein (EIV). B, Strongly estrogen receptor-positive staining and mild progesterone receptor-positive staining of smooth muscle cells.