Intravenous leiomyomatosis of the uterus: A case report and literature review.

Abstract

Intravenous leiomyomatosis (IVL) is a rare benign ovarian tumor that predominantly affects women of reproductive and perimenopausal age, and is often accompanied by uterine fibroids. Patients typically present with symptoms such as menorrhagia, anemia, dysmenorrhea, abdominal pain or a palpable abdominal mass. In its early stages, the clinical manifestations of this disease are highly nonspecific and lack typical features, leading to a high rate of underdiagnosis or misdiagnosis in clinical practice. IVL is classified as a borderline tumor due to its histologically benign characteristics but biologically malignant behaviors, such as vascular invasion and distant spread. When the lesion extends to involve the inferior vena cava or even the heart, recurrent syncope may become the predominant clinical manifestation. With disease progression, sudden cardiac arrest of a fatal type may occur. Surgical resection remains the primary treatment for this condition. Given its high recurrence rate, post-operative follow-up should be conducted in a manner similar to that for malignant tumors, with regular imaging surveillance. To enhance clinical awareness of IVL, the present study describes a case of IVL in a patient whose chief complaint was increased menstrual flow, an atypical presentation. By reviewing the current case, practical insights may be provided into the diagnosis and management of IVL.