Kudaka Wataru, Inafuku Hitoshi, Iraha Yuko, Nakamoto Tomoko, Taira Yusuke, Taira Rie, Kamiya Hisashi, Tsubakimoto Maho, Totsuka Yuichi, Kuniyoshi Yukio, Tamaki Tomoko, Aoyama Hajime, Saio Masanao, Yoshimi Naoki, Aoki Yoichi
Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
Case Rep Obstet Gynecol. 2016;2016:3467849. doi: 10.1155/2016/3467849. Epub 2016 Apr 27.
Background. A rare case of low-grade endometrial stromal sarcoma (LG-ESS) extending to inferior vena cava (IVC) and cardiac chambers. Case Report. A 40-year-old woman had IVC tumor, which was incidentally detected by abdominal ultrasonography during a routine medical checkup. CT scan revealed a tumor in IVC, right iliac and ovarian veins, which was derived from the uterus and extended into the right atrium and ventricle. The operation was performed, the heart and IVC were exposed, and cardiopulmonary bypass was initiated. A right atriotomy was performed, and the intracardiac mass was removed. Then the tumor in IVC and the right internal iliac vein were removed after longitudinal venotomies in the suprarenal and infrarenal vena cava, the right common iliac vein. Next the pelvis was explored. Tumors were found originating from the posterior wall of the uterus and continuing into both the right uterine and ovarian vein. The patient underwent total hysterectomy with bilateral salpingooophorectomy. Complete tumor resection was achieved. Histopathological analysis confirmed a diagnosis of LG-ESS. She showed no evidence of disease for 2 years and 3 months. Conclusions. Our case highlights the importance of a multidisciplinary approach in treating this rare cardiovascular pathological condition through preoperative assessment to final operation.
背景。一例罕见的低度子宫内膜间质肉瘤（LG-ESS）延伸至下腔静脉（IVC）和心腔。病例报告。一名40岁女性患有IVC肿瘤，在常规体检期间经腹部超声偶然发现。CT扫描显示IVC、右髂静脉和卵巢静脉有肿瘤，该肿瘤起源于子宫并延伸至右心房和心室。进行了手术，暴露心脏和IVC，并启动体外循环。进行了右心房切开术，切除心内肿块。然后在肾上腺上、下腔静脉及右髂总静脉纵向切开静脉后，切除IVC和右髂内静脉的肿瘤。接下来探查盆腔。发现肿瘤起源于子宫后壁并延续至右侧子宫和卵巢静脉。患者接受了全子宫切除术及双侧输卵管卵巢切除术。实现了肿瘤的完全切除。组织病理学分析确诊为LG-ESS。她在2年3个月内无疾病证据。结论。我们的病例强调了多学科方法在通过术前评估至最终手术治疗这种罕见心血管病理状况中的重要性。
