A Unique Case of Uterine Leiomyoma Metastasis to the Heart Uterine Leiomyoma with Cardiac Metastasis

Smooth muscle tumors of the heart are exceedingly rare and typically manifest in three clinical scenarios: as extensions of pelvic leiomyomas into cardiac vasculature, benign metastases from uterine leiomyomas, or as primary cardiac tumors. We present the case of a 50-year-old patient with a history of cardiac rhabdomyoma resection. She presented with symptoms suggestive of right heart failure, notably exertional dyspnea and syncopal episodes. Additionally, a palpable mass in the abdomen was noted, alongside a history of multiple masses in different locations. Diagnostic assessment revealed a mass within the right atrium, likely causing dynamic obstruction. Furthermore, extensive imaging revealed a sizable pelvic mass requiring surgical intervention. The patient underwent a two-stage surgical procedure. The first stage involved tumor resection from the abdomen, conducted by the gynecologic oncology team, with assistance from cardiothoracic surgery to assess its extension within the inferior vena cava. Subsequently, the cardiac mass was excised during the second stage of the surgery. Pathological examination of the mass from the cavo-atrial junction reported a leiomyoma with benign features. This case highlights the challenges in the differential diagnosis of cardiac tumors and the importance of multidisciplinary approaches involving specialists in gynecology-oncology, cardiovascular surgery and cardiology.