Clinical analysis of nine cases of uterine intravenous leiomyomatosis and review of the literature

Intravenous leiomyomatosis (IVL) is a rare and special type variant of leiomyoma characterized by intravascular proliferation of benign smooth muscle cells extending beyond the uterus into the heart and even to the pulmonary arteries through a variety of ways. Owing to its rare occurrence and lacking of obvious symptoms, early diagnosis is very difficult. Complete excision of tumors is vital for a favorable prognosis. There is no consensus about the operative drug-assisted treatment to reduce the risk of recurrence. Pathogenesis of IVL is not clear, and chromosomal and genetic changes may accelerated the development of IVL. Herein, we report 9 patients with early stage IVL. Nine patients were admitted to the hospital with different symptoms for surgical treatment, and postoperative pathology was suggestive of intravascular smooth muscle tumor. Close follow-up of the patient post-operatively revealed that hysterectomy and bilateral adnexectomy could be chosen when the mass was limited to the uterus or pelvic cavity, and for patients with fertility requirements, myomectomy might also be feasible. About hormonal or the other adjuvant therapies after operation, there are still controversies, and further studies are needed to verify these findings. We retrospectively analyzed the clinical data of the patients and explored their clinical features, treatment and prognosis, aiming to improve the understanding of this disease.