Successful extraction of cardiac extending intravenous leiomyomatosis through gonadal vein

Capsule:
To our knowledge, this is the first case report describing a cardiac-extending IV leiomyomatosis successfully extracted from the gonadal vein without sternotomy.

Authors:
Koji Matsuo, M.D., Farnardo Fleishman, M.D., Christian S. Ghattas, M.D., Anna S. Gabrielyan, M.D., Charles A. Ballard, M.D., Lynda D. Roman, M.D., C. Paul Morrow, M.D.

Volume 98, Issue 5, Pages 1341-1345.e1, November 2012

Abstract:

Objective:
To report a conservative surgical management of cardiac-extending intravenous leiomyomatosis.

Design:
Case report.

Setting:
Tertiary care center.

Patient(s):
A 40-year-old nulligravid with incidentally identified intravenous leiomyomatosis arising from the right gonadal vein and extending into the right atrium.

Intervention(s):
First, intraoperative transesophageal echocardiogram was performed that demonstrated the intravenous leiomyomatosis stalk to be 1.1cm diameter without an enlarged tip or adherence to the vessel lumen. Next, the 20-week size uterus was gently pulled caudally under live-visualization of the intravenous leiomyomatosis tip with transesophageal echocardiogram. As the uterus was pulled caudally, the intravenous leiomyomatosis tip obviously protruded from the right atrium and down into inferior vena cava. Lastly, the gonadal vein was incised longitudinally and the stalk of the tumor was grasped and extracted through the incision.

Main Outcome Measure(s):
One-step abdominal surgery for complete tumor resection without sternotomy or cardiac-bypass surgery.

Result(s):
To our knowledge, this is the first reported case of a cardiac-extending intravenous leiomyomatosis successfully extracted through the gonadal vein.

Conclusion(s):
In a selected case with logistic step-by-step approach, conservative surgical treatment via gonadal vein extraction could be a feasible option in the management of cardiac-extending intravenous leiomyomatosis. Systematic literature review highlights important clinical characteristics and management options for intravenous leiomyomatosis.

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