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Intracaval and intracardiac leiomyomatosis of uterine origin

Leyomioma intracava e intracardiaco de origen uterino

  • Case Reports
  • Published:
Annals of Vascular Surgery

Abstract

Intracaval leiomyomatosis of uterine origin is a rare disease. Extension to the right heart is exceptional. Based on the review of 11 cases reported in the literature and the case presented herein, which was treated successfully, the diagnostic and therapeutic problems are discussed. Diagnosis should be suggested when a female patient operated on previously for myofibroma of the uterus by hysterectomy, presents with a picture of cardiac myxoma. Diagnosis can be confirmed by iliocavogram and computerized tomography of the abdomen. Excision calls for a cardiac procedure under extracorporeal circulation and caval exploration which may be performed either simultaneously or as a two stage procedure.

Resumen

El leiomiosarcoma intracava de origen uterino es una enfermedad rara, que puede presentarr especiales características de complejidad y gravedad según la extensión del mismo. Se describe el caso de una mujer de 44 años que tras practicarle una histerectomía total con ovariectomía bilateral, presentó al año clínica cardiaca etiquetada de endocarditis bacteriana aguda, y a los tres se le diagnosticó un mixoma en auricula derecha. Con dicho diagnóstico se intervino quirurgicamente apreciando en la auricula una formación blanquecina, cilindrica y consistente, que provenía de la cava inferior y se prolongaba hasta el ventriculo derecho sin adherirse a las paredes vasculares. Se efectuó la resección a nivel del corazón. En el postoperatorio se practicó estudio flebográfico apreciando el origen de la masa en las venas iliaca externa y primitiva izquierda. A través de una laparotomía se realizó la extirpación del tumor a nivel de la cava inferior y venas iliacas primitiva y externa izquierdas, con ligadura de la hipogastrica. El postoperatorio y seguimiento hasta los 10 meses de evolución ha sido correcto y sin incidentes. El estudio anatomopatológico diagnosticó un leiomiosarcoma en todos los niveles extirpados. Deben diferenciarse los leiomiosarcomas intracava de origen uterino de los primitivos de cava inferior. Se caracterizan por estar constituidos por fibra muscular lisa originada en las venas uterinas o en fibromas uterinos. La posibilidad de metástasis renales y pulmonares, de recidivas y de poseer células inmaduras pueden evocar una cierta malignidad, pero de hecho el pronóstico suele ser benigno.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Ospedale Civile, Piazza d'Italia, 64100, Teramo, ITALY

    Alessandro Mazzola MD, Renato Gregorini MD, Beniamino Procaccini MD, Vincenzo Moretti MD, Ricardo Lucantoni MD, Wilmo Lorenzi MD, Giuseppe di Eusanio MD & Mauro Colombati MD

  2. Departments of Emergency Surgery, Ospedale Civile, Piazza d'Italia, 64100, Teramo, ITALY

    Alessandro Mazzola MD, Renato Gregorini MD, Beniamino Procaccini MD, Vincenzo Moretti MD, Ricardo Lucantoni MD, Wilmo Lorenzi MD, Giuseppe di Eusanio MD & Mauro Colombati MD

Authors
  1. Alessandro Mazzola MD
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  2. Renato Gregorini MD
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  3. Beniamino Procaccini MD
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  4. Vincenzo Moretti MD
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  5. Ricardo Lucantoni MD
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  6. Wilmo Lorenzi MD
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  7. Giuseppe di Eusanio MD
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  8. Mauro Colombati MD
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Mazzola, A., Gregorini, R., Procaccini, B. et al. Intracaval and intracardiac leiomyomatosis of uterine origin. Annals of Vascular Surgery 1, 134–138 (1986). https://doi.org/10.1007/BF02732469

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  • DOI: https://doi.org/10.1007/BF02732469

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