Intravenous Leiomyomatosis with Intracardiac Extension as a Rare Cause of Abdominal Pain in an Adult Patient: A Case Report

Abstract

Intravenous leiomyomatosis (IVL) is a rare and benign smooth muscle tumor that arises from intrauterine venules or the myometrium. We herein describe a 49-year-old woman with a history of myomectomy who developed abdominal pain. An intravascular mass with extension to the right atrium was detected in the inferior vena cava. The mass was surgically resected in a single stage under cardiopulmonary bypass. IVL features were indicated by subsequent histopathology. Postoperatively, the patient was diagnosed with massive pericardial effusion and treated with a pericardial window. At 3 months' outpatient clinical follow-up, she was asymptomatic. This case indicates that the diagnosis of IVL with extension to the heart should be kept in mind in patients presenting with abdominal pain.

Keywords: Heart neoplasm, Adult; Leiomyomatosis.

Figure 1

A) Contrast-enhanced computed tomogram of the abdomen image shows an intravenous leiomyomatosis (arrows) extending into the RA. B) Contrast-enhanced computed tomogram of the abdomen image shows an intravenous leiomyomatosis (arrow) extending from the IVC into RA.

Figure 2

The intravenous leiomyomatosis, seen freely floating here (arrow), was subsequently freed by blunt finger dissection.

Figure 3

A) The gross pathology of the tumor is firm, rubbery, and gray-white, which is compatible with intravenous leiomyoma. B) The hematoxylin stain (x 200) of the tumor shows spindle to stellate-shaped cells without any abnormal mitotic figures, which is compatible with intravenous leiomyoma. C) The immunohistochemistry staining (x 200) of the tumor shows the presence of caldesmon, which is compatible with intravenous leiomyoma. D) The immunohistochemistry staining (x 200) of the intravenous leiomyoma shows the presence of actin, which is compatible with intravenous leiomyoma.