Imaging Pearls ❯ OB GYN ❯ Intravenous leiomyomatosis
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- “Intravenous leiomyomatosis (IVL) is a rare gynecologic disease characterized by overgrowth of histologically benign smooth muscle within the lumen of pelvic and systemic veins. IVL was originally described in 1896 in an autopsy case by Birch-Hirschfeld . Subsequently, in 1907, Durk reported the first case of IVL with intracardiac extension. Yet it was not until 1959 that the earliest case by Marshall and Morris was described in the English literature.”
Intravenous Leiomyomatosis with Intracaval and Intracardiac Involvement
Low G et al
Radiology. 2012 Dec;265(3):971-5. - “IVL generally occurs in premenopausal parous white women (median age, 44 years; age range, 28–80 years) (8). It has a recognized association with a history of prior hysterectomy for uterine leiomyomas. In a review, Lam et al (6) found a history of hysterectomy in 38 (55.9%) of 68 patients with IVL with intracardiac extension.”
Intravenous Leiomyomatosis with Intracaval and Intracardiac Involvement
Low G et al
Radiology. 2012 Dec;265(3):971-5. - “Aside from IVL, the differential diagnosis for a contiguous intracaval and intracardiac soft-tissue mass includes bland thrombus, primary caval leiomyosarcoma, and tumor thrombus (from renal cell carcinoma, adrenal cortical carcinoma, or hepatocellular carcinoma in adults and from Wilm tumor in children).”
Intravenous Leiomyomatosis with Intracaval and Intracardiac Involvement
Low G et al
Radiology. 2012 Dec;265(3):971-5. - “Aside from IVL, the differential diagnosis for a contiguous intracaval and intracardiac soft-tissue mass includes bland thrombus, primary caval leiomyosarcoma, and tumor thrombus (from renal cell carcinoma, adrenal cortical carcinoma, or hepatocellular carcinoma in adults and from Wilm tumor in children).”
Intravenous Leiomyomatosis with Intracaval and Intracardiac Involvement
Low G et al
Radiology. 2012 Dec;265(3):971-5. - “Surgery is the treatment of choice for IVL. This involves total hysterectomy, bilateral salpingo-oophorectomy (as the tumor is estrogen dependent), and removal of the intravenous tumor. IVL typically adheres to but does not invade the vessel wall. Thus, if IVL extends into the IVC only, it can usually be removed by downward traction from the ovarian vein, iliac vein, or IVC at venotomy. However, a multidisciplinary surgical approach is required if there is intracardiac extension.”
Intravenous Leiomyomatosis with Intracaval and Intracardiac Involvement
Low G et al
Radiology. 2012 Dec;265(3):971-5.