Clinical analysis of postmenopausal women with intravenous leiomyomatosis

OBJECTIVE: Intravenous leiomyomatosis is a rare disease that occurs in premenopausal women. We examined the clinical characteristics, diagnosis, and therapeutic approaches of intravenous leiomyomatosis in postmenopausal women. MATERIALS AND METHODS: The clinical records of 20 menopausal patients with intravenous leiomyomatosis who were admitted to Peking Union Medical College Hospital between January 2014 and September 2021 were retrospectively analyzed. RESULTS: The mean patient age was 54.95 years (±standard deviation: ±5.2). Ten patients had a history of uterine leiomyomas before menopause. Nine patients had lesions in the pelvic cavity, and 11 had lesions in the microvasculature or heart, including in the iliac vein, inferior vena cava, right heart, and pulmonary artery. All 20 patients were treated by surgical excision, and 19 underwent one-stage surgery. All patients underwent histopathological examination, and nine underwent immunohistochemical analysis; seven were positive for cluster of differentiation 31/34 and four were positive for estrogen receptor or progesterone receptor. Six patients without a history of ovariectomy had a median serum estradiol level of 30.80 pg/mL before surgery, which significantly decreased to 14.5 pg/mL after surgery. The postoperative follow-up duration was 10-108 months (mean: 45 months). Nineteen patients completed the study, and one was lost to follow-up. At the last follow-up, 19 patients had no evidence of recurrence. CONCLUSION: The incidence of intravenous leiomyomatosis is low in postmenopausal women, although it is commonly misdiagnosed. Most patients have a history of uterine fibroids before menopause. Intravenous leiomyomatosis is treated via surgical resection, and it has a low postoperative recurrence rate.