Recurrent Pelvic Intravenous Leiomyomatosis After Vaginal Hysterectomy

Abstract

Diffuse pelvic leiomyomatosis is a rare, benign entity. Vaginal and vesical leiomyomas are particularly rare compared to uterine leiomyomas, with less than 200 cases reported. Uterine leiomyomas are more prevalent in women of African descent, while vesical and vaginal leiomyomas are most often found in Caucasian women. We believe that intravenous leiomyomatosis (IVL) is underdiagnosed because of a failure to appreciate the early states of tumor development and inadequate sampling of all uterine leiomyomas. The uniformly good prognosis is partially related to surgical resection at an early state of tumor development and partially to the benign biologic behavior of IVL even in the presence of metastases. We report the fifth case of recurrent IVL. In four of the five cases, there was functioning ovarian tissue at the time of recurrence; therefore, the possible etiologic role of endogenous estrogen in recurrence is discussed. Therapy should include bilateral oophorectomy.