Background: We report a case of intravenous leiomyoma (IVL) presenting as fibroid mass in a 50-year-old postmenopausal woman. The case is presented for awareness in view of its silent symptomatology, and an attempt is made to define therapy based on hormonal status. Case: On laparotomy, the fibroid mass extended into the broad ligament with unresectable planes. The diagnosis of IVL was made on histopathology examination of sub-total hysterectomy specimen. The residual intravenous leiomyoma mass was treated postoperatively with GnRH analogue, and antiprogestin based on its receptor status. There was minimal decrease in the size of the mass following hormonal therapy, but the patient remained asymptomatic with no further increase in size of tumor. Conclusions: IVL is a diagnosis that is almost always retrospective, and treatment guidelines are obscure for unresectable tumor. An antiprogesterone, mifepristone, was tried for the first time in our case in view of estrogen-negative and only progesterone-positive receptor status. Patients can be offered adjuvant therapy for receptor-positive residual IVL mass, yet the hormonal responsiveness of IVL remains unpredictable. (J GYNECOL SURG 26:207)
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References
1.
DankoroA, FoucherE, GrossinM, MandelbrotL. Intravascular leiomyomatosis of the uterus: Two cases and review of the literature. J Gynecol Obstet Biol Reprod (Paris), 2004; 33:753.
2.
CastelliP, CaronnoR, PiffarettiG, TozziM. Intravenous uterine leiomyomatosis with right heart extension: Successful two-stage surgical removal. Ann Vasc Surg, 2006; 20:405.
3.
CohenDT, OlivaE, HahnPF, FullerAFJr, LeeSI. Uterine smooth-muscle tumors with unusual growth patterns: Imaging with pathologic correlation. Am J Roentgenol, 2007; 188:246.
4.
ChenMJ, PengY, YangYS, HuangSC, ChowSN, TorngPL. Increased hyaluronan and CD4 expressions in intravenous leiomyomatosis. Acta Obstet Gynecol Scand, 2005; 84:322.
5.
ArifS, GanesanR, SpoonerD. Intravascular leiomyomatosis and benign metastasizing leiomyoma: An unusual case. Int J Gynecol Cancer, 2006; 16:1448.
6.
KirG, KirM, GurbuzA, KaratekeA, AkerF. Estrogen and progesterone expression of vessel walls with intravascular leiomyomatosis; discussion of histogenesis. Eur J Gynaecol Oncol, 2004; 25:362.
7.
MitsuhashiA, NagaiY, SugitaM, NakajimaN, SekiyaS. GnRH agonist for intravenous leiomyomatosis with cardiac extension: A case report. J Reprod Med, 1999; 44:883.
8.
BodnerK, Bodner-AdlerB, WierraniF, MayerhoferK, GrünbergerW. Intravenous leiomyomatosis of the uterus. Anticancer Res, 2002; 22:1881.
9.
LamPM, LoKW, YuMM, LauTK, CheungTH. Intravenous leiomyomatosis with atypical histologic features: A case report. Int J Gynecol Cancer, 2003; 13:83.
10.
FiscellaK, EisingerSH, MeldrumS, FengC, FisherSG, GuzickDS. Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: A randomized controlled trial. Obstet Gynecol, 2006; 108:1381.
