Clinical challenge of benign metastasizing leiomyoma with cardiac and hepatic involvement: A case report

Q4 Medicine
Huong Thi Thu Vu MD , Hanh Thi Song Bui MD , Hien Quang Nguyen MD , Hai Phuong Huynh MD , Duc Tan Vo MD, PhD , Dinh Hoang Nguyen MD, PhD , Thang Nhat Tran MD, PhD , Minh Huu Nhat Le MD, PhD candidate
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Abstract

Benign metastasizing leiomyoma (BML) is a rare disorder occurring in women with a history of uterine leiomyomas and having detection of leiomyomas in extrauterine locations. This case report describes a 39-year-old female with a six-month history of fatigue and worsening exertional dyspnea. She had undergone a previous myomectomy due to multiple uterine fibroids. A transthoracic echocardiogram revealed a large mass involving the right atrium and the inferior vena cava. Chest and abdominal computed tomography scans demonstrated the presence of this mass in the right hepatic vein, along with a nodule in the right lobe of the liver and multiple uterine fibroids. She underwent surgery to remove the cardiovascular mass, and histopathological results confirmed the benign nature of the smooth muscle cells. Immunohistochemical staining was positive for actin, progesterone receptor, desmin, and Ki67, consistent with a diagnosis of BML. Subsequently, she underwent hysterectomy and bilateral salpingo-oophorectomy, revealing a benign leiomyoma and endometriosis. This case emphasizes the importance of imaging in accurately diagnosing and preoperatively evaluating cardiac mass.

Learning objective

Benign metastasizing leiomyoma should be considered in patients presenting with an atypical cardiac mass and a history of uterine leiomyoma, myomectomy, or hysterectomy. Multiple imaging modalities are crucial for diagnosis, preoperative evaluation, and surgical treatment guidance.
良性转移性平滑肌瘤累及心脏和肝脏的临床挑战:1例报告
良性转移性平滑肌瘤(BML)是一种罕见的疾病,发生在子宫平滑肌瘤病史和子宫外部位平滑肌瘤的妇女。本病例报告描述了一名39岁的女性,有六个月的疲劳史和日益严重的用力呼吸困难。她曾因多发性子宫肌瘤做过子宫肌瘤切除术。经胸超声心动图显示一个大肿块累及右心房和下腔静脉。胸部和腹部计算机断层扫描显示右肝静脉有肿块,肝右叶有结节和多个子宫肌瘤。她接受手术切除了心血管肿块,组织病理学结果证实了平滑肌细胞的良性性质。免疫组化染色肌动蛋白、孕酮受体、desmin和Ki67阳性,符合BML的诊断。随后,她接受了子宫切除术和双侧输卵管卵巢切除术,发现良性平滑肌瘤和子宫内膜异位症。这个病例强调了影像在准确诊断和术前评估心脏肿块中的重要性。学习目的:有非典型心脏肿块和子宫平滑肌瘤、子宫肌瘤切除术或子宫切除术史的患者应考虑良性转移性平滑肌瘤。多种成像方式对诊断、术前评估和手术治疗指导至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Cardiology Cases
Journal of Cardiology Cases Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.90
自引率
0.00%
发文量
177
审稿时长
59 days
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