An Intravenous leiomyoma with cardiac involvement in a patient with uterine leiomyoma

A case of intravenous leiomyomatosis (IVL) invading the vena cava and extending to the right atrium, a rare benign smooth-muscle tumor, is described. Despite their histological benignity, these lesions have a tendency to metastasize and are closely related to the condition called 'benign metastasizing leiomyoma' and 'intracaval mass and cardiac extension'. A 50-year old woman was admitted to the hospital with dyspnea beginning 6 months ago and previous history of hysterectomy due to uterine myoma. Echocarcliography revealed severe tricuspid valve insufficiency and a mobile elongated mass which occupied the inferior vena cava and was extending into the right ventricular cavity. Pelvic ultrasonography and pelvic MRI identified suspicious metastasis to both ovaries and peritoneum. She underwent resection of the cardiac tumor, concomitant tricuspid annuloplasty with a closure of the foramen ovale and both salphyngo-oophorectomy with vaginal stump mass biopsy. All of them could be histologically identified as IVL.