Yang Yixuan, Ma Guotao, Lai Zhichao, Ma Xiao, Cao Dongyan, Li Kang, Shao Jiang, Liu Bao
Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China.
Medicine (Baltimore). 2025 Sep 19;104(38):e43961. doi: 10.1097/MD.0000000000043961.
Intravenous leiomyomatosis (IVL) and uterine leiomyosarcoma (ULMS) share overlapping imaging features, leading to frequent preoperative misdiagnosis. Accurate differentiation is critical for appropriate surgical management.
Case 1 is a 48-year-old woman with intermittent vaginal bleeding. Case 2 is a 52-year-old woman with exertional dyspnea for 8 months.
Preoperative computed tomography venography suggested IVL in both cases. Final pathology showed case 1 for low-grade endometrial stromal sarcoma with vascular invasion and case 2 for ULMS.
Case 1 under hysterectomy, bilateral salpingoo-opherectomy, ureteral replantation, tumor resection. Case 2 under resection of uterus, adnexa, right kidney, and intravascular tumor.
Both cases showed a fine postoperative condition with no severe adverse reactions.
Intraoperative pathology is essential for distinguishing ULMS from IVL when imaging is inconclusive.
静脉内平滑肌瘤病（IVL）和子宫平滑肌肉瘤（ULMS）具有重叠的影像学特征，导致术前经常误诊。准确鉴别对于恰当的手术管理至关重要。
病例1是一名48岁间歇性阴道出血的女性。病例2是一名52岁劳力性呼吸困难8个月的女性。
术前计算机断层扫描静脉造影在两例中均提示IVL。最终病理显示病例1为伴有血管侵犯的低级别子宫内膜间质肉瘤，病例2为ULMS。
病例1行子宫切除术、双侧输卵管卵巢切除术、输尿管再植术、肿瘤切除术。病例2行子宫、附件、右肾及血管内肿瘤切除术。
两例术后情况良好，无严重不良反应。
当影像学检查结果不明确时，术中病理对于区分ULMS和IVL至关重要。
