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Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Multidisciplinary Approach.

Kudaka W, Inafuku H, Iraha Y, Nakamoto T, Taira Y, Taira R, Kamiya H, Tsubakimoto M, Totsuka Y, Kuniyoshi Y, Tamaki T, Aoyama H, Saio M, Yoshimi N, Aoki Y - Case Rep Obstet Gynecol (2016)

Bottom Line: Histopathological analysis confirmed a diagnosis of LG-ESS.Conclusions.Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.

ABSTRACT
Background. A rare case of low-grade endometrial stromal sarcoma (LG-ESS) extending to inferior vena cava (IVC) and cardiac chambers. Case Report. A 40-year-old woman had IVC tumor, which was incidentally detected by abdominal ultrasonography during a routine medical checkup. CT scan revealed a tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. The operation was performed, the heart and IVC were exposed, and cardiopulmonary bypass was initiated. A right atriotomy was performed, and the intracardiac mass was removed. Then the tumor in IVC and the right internal iliac vein were removed after longitudinal venotomies in the suprarenal and infrarenal vena cava, the right common iliac vein. Next the pelvis was explored. Tumors were found originating from the posterior wall of the uterus and continuing into both the right uterine and ovarian vein. The patient underwent total hysterectomy with bilateral salpingooophorectomy. Complete tumor resection was achieved. Histopathological analysis confirmed a diagnosis of LG-ESS. She showed no evidence of disease for 2 years and 3 months. Conclusions. Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging (MRI): (a) on T2 weighted image, an irregular tumor is identified in the right posterior wall of the uterus, which exhibited heterogeneous high signal intensity (arrowheads); (b) the right uterine vein and ovarian vein are dilated, and low and high intensity masses are depicted in the veins and originated from the high intensity tumor in the posterior uterine wall (arrowheads); (c) sagittal view of dynamic contrast-enhanced MRI demonstrates large filling defect in the inferior vena cava with gradually increasing enhancement (upper arrowheads) and poor enhancement of tumor in the posterior uterine wall (lower arrowheads).
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fig2: Magnetic resonance imaging (MRI): (a) on T2 weighted image, an irregular tumor is identified in the right posterior wall of the uterus, which exhibited heterogeneous high signal intensity (arrowheads); (b) the right uterine vein and ovarian vein are dilated, and low and high intensity masses are depicted in the veins and originated from the high intensity tumor in the posterior uterine wall (arrowheads); (c) sagittal view of dynamic contrast-enhanced MRI demonstrates large filling defect in the inferior vena cava with gradually increasing enhancement (upper arrowheads) and poor enhancement of tumor in the posterior uterine wall (lower arrowheads).

Mentions: A 40-year-old woman had received regular follow-up for a fatty liver, and inferior vena cava (IVC) tumor, which was initially thought to be a blood thrombus, was incidentally detected by abdominal ultrasonography during a routine medical checkup. She was subsequently referred to our hospital for investigation. Computed tomography (CT) of the chest, abdomen, and pelvis revealed a large tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. We identified two extension pathways of intravenous tumor originated from the posterior uterine wall (Figure 1). Furthermore, the thrombus showed enhancement after administration of contrast material, which was indicative of tumor thrombus or benign metastasizing leiomyomatosis. On pelvic magnetic resonance imaging (MRI), an irregular tumor was identified in the right posterior wall of the uterus, which exhibited heterogeneous high signal intensity on T2-weighted images. Dynamic contrast-enhanced MRI using gadolinium with diethylenetriaminepentaacetate revealed the enhancement of the tumor in IVC (Figure 2). Because the lesion was located in the right atrium and ventricle, cardiovascular surgery consultation was recommended. A transthoracic echocardiogram was duly performed and revealed the tip of the tumor extended into the right atrium and also into the right ventricle. The multidisciplinary evaluation of the patient indicated that this was a case of cardiac-extending intravenous (IV) leiomyomatosis through the right ovarian and uterine veins arising from the uterine tumor.


Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Multidisciplinary Approach.

Kudaka W, Inafuku H, Iraha Y, Nakamoto T, Taira Y, Taira R, Kamiya H, Tsubakimoto M, Totsuka Y, Kuniyoshi Y, Tamaki T, Aoyama H, Saio M, Yoshimi N, Aoki Y - Case Rep Obstet Gynecol (2016)

Magnetic resonance imaging (MRI): (a) on T2 weighted image, an irregular tumor is identified in the right posterior wall of the uterus, which exhibited heterogeneous high signal intensity (arrowheads); (b) the right uterine vein and ovarian vein are dilated, and low and high intensity masses are depicted in the veins and originated from the high intensity tumor in the posterior uterine wall (arrowheads); (c) sagittal view of dynamic contrast-enhanced MRI demonstrates large filling defect in the inferior vena cava with gradually increasing enhancement (upper arrowheads) and poor enhancement of tumor in the posterior uterine wall (lower arrowheads).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4863127&req=5

fig2: Magnetic resonance imaging (MRI): (a) on T2 weighted image, an irregular tumor is identified in the right posterior wall of the uterus, which exhibited heterogeneous high signal intensity (arrowheads); (b) the right uterine vein and ovarian vein are dilated, and low and high intensity masses are depicted in the veins and originated from the high intensity tumor in the posterior uterine wall (arrowheads); (c) sagittal view of dynamic contrast-enhanced MRI demonstrates large filling defect in the inferior vena cava with gradually increasing enhancement (upper arrowheads) and poor enhancement of tumor in the posterior uterine wall (lower arrowheads).
Mentions: A 40-year-old woman had received regular follow-up for a fatty liver, and inferior vena cava (IVC) tumor, which was initially thought to be a blood thrombus, was incidentally detected by abdominal ultrasonography during a routine medical checkup. She was subsequently referred to our hospital for investigation. Computed tomography (CT) of the chest, abdomen, and pelvis revealed a large tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. We identified two extension pathways of intravenous tumor originated from the posterior uterine wall (Figure 1). Furthermore, the thrombus showed enhancement after administration of contrast material, which was indicative of tumor thrombus or benign metastasizing leiomyomatosis. On pelvic magnetic resonance imaging (MRI), an irregular tumor was identified in the right posterior wall of the uterus, which exhibited heterogeneous high signal intensity on T2-weighted images. Dynamic contrast-enhanced MRI using gadolinium with diethylenetriaminepentaacetate revealed the enhancement of the tumor in IVC (Figure 2). Because the lesion was located in the right atrium and ventricle, cardiovascular surgery consultation was recommended. A transthoracic echocardiogram was duly performed and revealed the tip of the tumor extended into the right atrium and also into the right ventricle. The multidisciplinary evaluation of the patient indicated that this was a case of cardiac-extending intravenous (IV) leiomyomatosis through the right ovarian and uterine veins arising from the uterine tumor.

Bottom Line: Histopathological analysis confirmed a diagnosis of LG-ESS.Conclusions.Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.

ABSTRACT
Background. A rare case of low-grade endometrial stromal sarcoma (LG-ESS) extending to inferior vena cava (IVC) and cardiac chambers. Case Report. A 40-year-old woman had IVC tumor, which was incidentally detected by abdominal ultrasonography during a routine medical checkup. CT scan revealed a tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. The operation was performed, the heart and IVC were exposed, and cardiopulmonary bypass was initiated. A right atriotomy was performed, and the intracardiac mass was removed. Then the tumor in IVC and the right internal iliac vein were removed after longitudinal venotomies in the suprarenal and infrarenal vena cava, the right common iliac vein. Next the pelvis was explored. Tumors were found originating from the posterior wall of the uterus and continuing into both the right uterine and ovarian vein. The patient underwent total hysterectomy with bilateral salpingooophorectomy. Complete tumor resection was achieved. Histopathological analysis confirmed a diagnosis of LG-ESS. She showed no evidence of disease for 2 years and 3 months. Conclusions. Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.

No MeSH data available.


Related in: MedlinePlus