INTRAVASCULAR LEIOMYOMATOSIS IN A PREMENOPAUSAL WOMAN: A CASE REPORT

Abstract

Introduction: Leiomyomas are the most common uterine neoplasms. In some cases, they may exhibit vascular invasion, with the main risk factor being the presence of a concomitant myoma. Although benign, they can behave aggressively, with potential invasion of the inferior vena cava and even the heart chambers, requiring surgical treatment. Case Report: A 39-year-old woman, with three previous cesarean deliveries and no known comorbidities, sought medical attention due to abdominal enlargement, early satiety, constipation, and weight loss. On physical examination, there was abdominal tenderness and a palpable mass. An initial abdominal ultrasound revealed a mixed mass. A subsequent transvaginal ultrasound identified a hyperechoic image. A computed tomography (CT) scan of the abdomen and pelvis showed a large, heterogeneous expansile lesion, partially delimited, displacing adjacent structures, and with free fluid in the abdominal cavity. An elective surgery was indicated, and the patient underwent exploratory laparotomy, total extrafascial hysterectomy, left salpingo-oophorectomy, and right salpingectomy. The histopathological examination confirmed the diagnosis of intravascular leiomyomatosis. The patient recovered well postoperatively and was discharged with outpatient follow-up recommendations. Conclusion: Intravascular leiomyomatosis is a rare but significant condition due to its aggressive behavior, with potential invasion of major vessels and cardiac chambers. Early recognition is essential to prevent serious complications.