Medicine · 2018
One-stage surgery for removal of intravascular leiomyomatosis extending to right ventricle.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Chiang Ching-Shu, Chen Po-Lin, Kuo Tzu-Ting, Chen I-Ming, Wu Nai-Yuan, Chang Hsiao-Huang
Аннотация
RATIONALE: Intravascular leiomyomatosis (IVL) is a rare nonmalignant tumor that can be fatal if untreated.
PATIENT CONCERNS: A 49-year-old nulliparous Asian woman who underwent hysterectomy and left salpingo-oophorectomy for multiple uterine leiomyomas 18 months prior presented complaining of intermittent palpitation and chest tightness for approximately 1 month. Echocardiography revealed a large mobile tumor mass extending from the inferior vena cava (IVC) to the right atrium that partially obstructed IVC flow and tricuspid inflow. Thoracicabdominopelvic computed tomography revealed a left adnexal tumor (4.8 × 2.5 cm) causing intravascular obstruction extending from the left internal iliac vein to the IVC, right atrium, and right ventricle.
DIAGNOSIS: IVL with right heart involvement INTERVENTIONS:: Under cardiopulmonary bypass, a one-stage surgery combining sternotomy and laparotomy was performed. The tumor was approached and extracted via sternotomy, and tumor detachment and removal of residual tumors was accomplished via laparotomy.
OUTCOMES: A firm, smooth, and regularly shape tumor 15.5 × 5.5 × 2.5 in size was completely removed and histopathologically confirmed as IVL. The patient tolerated the surgical procedure well and no postoperative complication was noted.
LESSONS: We describe a one-stage surgical approach to completely remove an IVL extending to the right ventricle.
PATIENT CONCERNS: A 49-year-old nulliparous Asian woman who underwent hysterectomy and left salpingo-oophorectomy for multiple uterine leiomyomas 18 months prior presented complaining of intermittent palpitation and chest tightness for approximately 1 month. Echocardiography revealed a large mobile tumor mass extending from the inferior vena cava (IVC) to the right atrium that partially obstructed IVC flow and tricuspid inflow. Thoracicabdominopelvic computed tomography revealed a left adnexal tumor (4.8 × 2.5 cm) causing intravascular obstruction extending from the left internal iliac vein to the IVC, right atrium, and right ventricle.
DIAGNOSIS: IVL with right heart involvement INTERVENTIONS:: Under cardiopulmonary bypass, a one-stage surgery combining sternotomy and laparotomy was performed. The tumor was approached and extracted via sternotomy, and tumor detachment and removal of residual tumors was accomplished via laparotomy.
OUTCOMES: A firm, smooth, and regularly shape tumor 15.5 × 5.5 × 2.5 in size was completely removed and histopathologically confirmed as IVL. The patient tolerated the surgical procedure well and no postoperative complication was noted.
LESSONS: We describe a one-stage surgical approach to completely remove an IVL extending to the right ventricle.
Предметные рубрики MeSH
Cardiopulmonary BypassDissectionEchocardiographyFemaleHeart AtriaHeart NeoplasmsHeart VentriclesHumansHysterectomyLaparotomyLeiomyomatosisMiddle AgedNeoplasm InvasivenessSternotomyTomography, X-Ray ComputedTreatment OutcomeUterine NeoplasmsVascular NeoplasmsVascular Surgical ProceduresVena Cava, Inferior