A case of incidental intravenous leiomyomatosis noted four years after laparoscopic myomectomy

Intravenous leiomyomatosis (IVL) is a rare disorder among benign leiomyomas, which may arise from uterine myoma or smooth muscle of the vessel wall, extend into the veins. It sometimes extends into the inferior vena cava or the right atrium, causing a serious condition that can lead to sudden death. A 32-year-old nulliparous woman underwent laparoscopic myomectomy for a degenerative myoma. Four years after the surgery, an indistinct borderline mass appeared in the uterine body, for which the possibility of a degenerative myoma or sarcoma could not be ruled out. After preoperative blood tests, contrast-enhanced CT scan, and MRI, total hysterectomy was performed. Intraoperatively, an elastic hard mass was palpated in the left ovarian adnexal vessels, and when the vessels were cut open to examine the interior, a leiomyoma-like mass was confirmed grossly. Suspecting IVL or another disease extending into the left ovarian adnexa, a left adnexectomy was additionally performed for diagnosis and to prevent dispersal of the embolus. Postoperative contrast-enhanced CT scan and a reexamination of the preoperative imaging studies revealed shadow defects in the iliac vein, the left renal vein, the inferior vena cava, and the right pulmonary artery. The patient was transferred to another hospital for tumor embolization in the inferior vena cava and iliac vein, bilateral ovarian vein ligation, bilateral internal iliac vein ligation, and right ovariectomy, and the diagnosis of IVL was confirmed.