Intravenous Leiomyomatosis of the Uterus: An Intriguing Case Revealed through Anatomopathological Examination

Abstract

INTRODUCTION: Intravenous leiomyomatosis (IVL), a rare type of uterine leiomyoma (its incidence is about 0.25% to 0.40% of patients who present uterine fibroma), is characterized by the formation and growth of benign leiomyoma tissue within the vascular wall or lymphatic lumen. Herein, we presented a case of early stage of IVL successfully treated by surgical removal and a review of actual medical recommendations. OBSERVATION: A 49-year-old woman, gravida 2 para 2, presented to our department with hypogastric pain. On physical examination, a palpable mass in the hypogastrium was noted. Pelvic ultrasound showed a huge uterus with multiple heterogeneous leiomyomas. As the patient was symptomatic and as she had completed their family plan, the decision to perform a total abdominal hysterectomy with bilateral salpingo-oophorectomy was taken. On pathological examination, intravascular growth of benign smooth muscle cell was found within venous channels lined by endothelium. The diagnosis of IVL of the uterus without malignant transformation was confirmed. The patient was monitored for 14 months, and subsequent computed tomography did not reveal any evidence of tumor recurrence. CONCLUSION: IVL is a benign, rare and potentially lethal pathology. Clinical manifestations are nonspecific. IVL needs surgical treatment for diagnosis and therapeutic purposes. They require close and prolonged follow-up because of the high risk of recurrence.