Learning objectives
Case report of intravenous leiomyomatosis on MRI,
review literature and discuss the role of MRI on this entity.
Background
Leiomyomas are neoplastic nodular and/or diffuse proliferation of histologically benign smooth muscle cells (figure 1).
By the way,
extrauterine intravenous leiomyomatosis are rare and represent intraluminal growth into either venous or lymphatic vessels outside the limits of myoma.
Intravenous leiomyomatosis may result from the invasion of myometrial sinuses by either leiomyomatosis cells or proliferating smooth muscle cells,
arising directly from the venous wall of the uterine or pelvic veins and are associated with high estrogen levels.
First described by Birch-Hirschfeld in 1896 and defined by...
Findings and procedure details
56y,
no symptoms,
presenting with greater vascularization on leiomyoma during routine US.
There was no previous pelvic surgery.
Climacteric without hormonal replacement therapy.
MRI shows expansive contrast enhancing tissue isointense of miometrial,
extending to left broad ligament and parametrial veins with minimal restricted diffusion (figures 6,
7,
8,
9 and 10).
Patient was submitted for a total histerectomy (figure 11).
Immunohistochemical demonstrated KI-67 positive expression (3% of all),
such as actin 1A4 and desmin.
There was no expression of CD10.Histopathological study confirmed intravenous leiomyomatosis.
Conclusion
Intravenous leiomyomatosis are uncommon and may mimic malignancy.
MRI and histopathologic study are a important role on this entity,
during involvement and follow up evaluation,
and on differential diagnosis,
respectively.
Antibodies against Factor VIII-related antigen desmin and smooth muscle actin,
confirm the presence of endothelium-covered proliferations of smooth muscle.
Recurrence after surgery have been reported and follow up is necessary.
Bender et al suggests 3,
6 and 12 months,
then annually imaging control with doppler US (including inferior cava vein and iliac veins) and MRI,...
References
Al-Daraji,
W,
Husain,
E,
Zelger,
BG and Zelger,
B.
A Practical and Comprehensive Immunohistochemical Approach to the Diagnosis of Superficial Soft Tissue Tumors. Int J Clin Exp Pathol (2009) 2,
119-131;
Bender,
LC,
Mitsumori,
LM,
Lloyd,
KA,
and Stambaugh,
LE.
MDAIRP Best Cases in Radiologic-Pathologic Correlation: Intravenous Leiomyomatosis. Radiographics 2011; 31: 1053-1058;
Canzonieri,
V,
D’Amore,
ESG,
Bartoloni,
G,
Piazza,
M,
Blandamura,
S and Carbone,
A.
Leiomyomatosis with vascular invasion.
A unified pathogenesis regarding leiomyoma with vascular microinvasion,
benign metastasizing leiomyoma and intravenous leiomyomatosis. Virchows Archly...