Intravascular leiomyoma with heart extension.

An intravascular (or intravenous) leiomyoma is a histologically benign tumor characterized by the proliferation of smooth muscle cells arising from the intrauterine venules and/or the myometrium (1-4); however, exceptional cases that arise from cutaneous vessels and pelvic or retroperitoneal veins have been found (5,6). This tumor affects only women, particularly middle-aged women (median age, 44 years) with a history of hysterectomy (4). Usually, an intravascular leiomyoma enters through the lumen of the iliac veins and grows into the inferior vena cava, sometimes reaching the right heart chambers (1-4,7-10). In this situation, one- or two-stage surgery has been used to prevent fatal complications (e.g., total tricuspid obstruction) (3,4,9-13). Here, we report the case of a 34-year-old totally asymptomatic woman with a history of uterine myoma and with evidence of a pelvic intracaval mass extending to the right atrium. The patient was treated with a one-stage surgical protocol that combined cardiac and vascular procedures in a thoracoabdominal approach under cardiopulmonary bypass at 32°C. The histological analysis of the excised specimen was consistent with an intravascular leiomyoma. The more recent findings on the pathogenesis, incidence, clinical presentation, diagnosis, and treatment of intravascular leiomyo are discussed in this communication.