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      Leiomiomatosis endoluminal de la vena cava inferior con extensión a la aurícula derecha. Abordaje multidisciplinario, reporte de caso clínico, revisión y actualización Translated title: Endoluminal leiomyomatosis of the lower vena cava with extension to the right atrium. Multidisciplinary approach, clinical case report, review and update

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          Abstract

          Resumen Presentamos el caso de una paciente de 57 años de edad a quien en el año 2018 realizaron una histerectomía abdominal total + salpingooforectomía derecha. Posteriormente, se hacen imágenes diagnósticas en las que se evidencia una lesión que ocupa la luz de la vena cava inferior y que se extiende desde la vena ilíaca derecha hasta la aurícula. Inicialmente se intenta extracción percutánea, que resulta fallida, por lo que se programa una cirugía abierta (laparotomía) junto al departamento de cirugía hepatobiliar y cardiovascular. En la sala de operaciones, se aborda por incisión de Mercedes Benz, se realiza desinserción y movilización hepática, exponiendo la vena cava inferior, se incide la misma y se procede a traccionar la masa tumoral hasta extraer la lesión completamente.

          Translated abstract

          Abstract We present a case of a 57-year-old patient who underwent total abdominal hysterectomy plus right salpingoophorectomy in 2018, subsequently performed diagnostic images showing an injury that occupies the lumen of the inferior vena cava and extends from the right iliac vein to the atrium; initially percutaneous extraction is attempted, which is failed, which is why the patient is scheduled for open surgery (laparotomy) in conjunction with the department of hepato-biliary and cardiovascular surgery; in the operating room, it is approached by incision of Mercedes Benz, performing disinsertion and hepatic mobilization exposing the inferior vena cava, the same is incised and the tumor mass is betrayed until the lesion is completely removed.

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          Intravenous leiomyomatosis of the uterus: a clinicopathologic study of 18 cases, with emphasis on early diagnosis and appropriate treatment strategies.

          Intravenous leiomyomatosis is a rare variant of leiomyoma that could result in death. Early and accurate diagnosis and appropriate treatment strategies play a dominant role in good prognosis. Eighteen cases of Intravenous leiomyomatosis , along with clinicopathologic data, were retrieved from our database. Most of the patients who ranged in age from 33 to 54 years (median, 44 years) presented with a pelvic mass or abnormal uterine bleeding. The diagnosis was confirmed by a immunohistochemical staining for smooth muscle actin, CD34, and Ki67. Surgical exploration confirmed the presence of a uterine mass (mean size, 5.08 cm). Wormlike plugs were identified within the broad ligament in 5 cases. The tumor penetrated to the inferior vena cava in 1 case. Histologic variants were noted in 33.33% (6/18) of our cases, which were classified as cellular intravenous leiomyomatosis (3 cases) and intravenous leiomyomatosis with papillary-like contour (1 case) and with fat metaplasia (2 cases). The 18 cases are made up 0.097% of all genital smooth muscle tumor cases of the hospital. The ratios of intravenous leiomyomatosis with uterine leiomyoma, with adenomyosis, with uterine leiomyoma and adenomyosis were 38.89% (7/18), 11.11% (2/18), and 27.78% (5/18), respectively. Follow-up information was available for 16 patients, with a follow-up duration of 26 to 104 months (mean, 55 months). Three cases (16.67%) recurred in patients younger than 40 years (33, 34, and 37 years). We propose that young patients undertake hysterectomy and unilateral salpingo-oophorectomy if they do not have any birthing requests. The cases of intravenous leiomyomatosis were underestimated because early diagnosis was easily missed. It is important to adequately sample all uterine leiomyomas and carefully examine the soft tissue on either side of the lower uterine segment below the peritoneal reflection to identify early-stage intravenous leiomyomatosis. Copyright © 2011 Elsevier Inc. All rights reserved.
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            Intravenous leiomyomatosis with cardiac extension: tumor thrombectomy through an abdominal approach.

            Intravenous leiomyomatosis is an uncommon vascular tumor that may be seen with potentially life-threatening symptoms resulting from intracardiac extension. This tumor is frequently misdiagnosed and treated without appropriate preoperative imaging and planning, which at times leads to inadequate treatment and incomplete resections. The appropriate therapy is complete excision of the tumor. We describe a patient who was treated with a new approach involving a single-stage operation without the need for median sternotomy, cardiopulmonary bypass graft, or hypothermic arrest by resection of the tumor from the point of attachment in the abdominal portion of the inferior vena cava.
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              High-output cardiac failure: an unusual manifestation of intravenous leiomyomatosis.

              Intravenous leiomyomatosis is a rare uterine neoplasm characterized by nodular or wormlike masses of histologically benign smooth muscle growing within myometrial veins and extending variable distances into the veins of contiguous organs and major pelvic veins. In some cases, there has been extension into the gonadal or iliac veins to the vena cava and right atrium, causing symptoms of congestive heart failure and an eventual fatal outcome. We present a report of the first case in which high-output cardiac failure was caused by the development of arteriovenous shunting within the intravenous component of the tumor that involved the pelvic organs and retroperitoneal and gonadal veins but not the vena cava. Treatment by total abdominal hysterectomy, bilateral oopherectomy, and tumor mass excision from the retroperitoneum was successful.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                August 2020
                : 72
                : 4
                : 204-208
                Affiliations
                [2] Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Departamento de Cirugía Vascular Colombia
                [1] Bogotá orgnameHospital Militar Central orgdiv1Servicio de Cirugía Vascular, Endovascular y Angiología orgdiv2Endovascular y Angiología Colombia
                Article
                S0003-31702020000400006 S0003-3170(20)07200400006
                10.20960/angiologia.00109
                ed371306-0c41-47b8-9965-8583f19f4858

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 10 January 2020
                : 15 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 5
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Tumor,Vena cava,Miomatosis,Mercedes Benz,Laparotomía,Leiomioma,Myomatosis,Anexial,leiomyoma,Laparotomy

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