Nakayama Y, Kitamura S, Kawachi K, Kawata T, Fukutomi M, Hasegawa J, Morita R
Department of Surgery III, Nara Medical College, Japan.
Cardiovasc Surg. 1994 Oct;2(5):642-5.
Intravenous leiomyomatosis, also called benign leiomyoma, is a rare tumour that originates from a uterine myoma and spreads intravenously. A 54-year-old woman who had experienced faintness after a hysterectomy for uterine myoma 10 years earlier presented with this lesion. Ultrasonographic, computed tomographic and angiographic examination revealed a long tumour that originated in the uterus and extended into the right atrium through the right internal iliac vein and inferior vena cava. On the basis of a diagnosis of intravenous leiomyomatosis the neoplasm was extirpated by a one-stage cardiotomy and laparotomy with the aid of cardiopulmonary bypass. Retrospective histological analysis of the excised uterus revealed tumorous thrombosis in the venous cavity of the tunica muscularis. Some 26 cases in which open-heart surgery has been undertaken for intracardiac tumour thrombosis have been reported. These and the case described here are reviewed and analysed. In the present case, a full view of the tumour was obtained before surgery, and the lesion removed by a one-stage procedure using median sternotomy (cardiotomy) and laparotomy. Reports of one-stage procedures are few; only eight (30%) of 27 cases.
静脉内平滑肌瘤病，也称为良性平滑肌瘤，是一种罕见的肿瘤，起源于子宫肌瘤并通过静脉扩散。一名54岁女性，10年前因子宫肌瘤行子宫切除术后出现昏厥，现患有此病变。超声、计算机断层扫描和血管造影检查显示，一个长肿瘤起源于子宫，通过右髂内静脉和下腔静脉延伸至右心房。基于静脉内平滑肌瘤病的诊断，在体外循环辅助下，通过一期心脏切开术和剖腹术切除肿瘤。对切除子宫的回顾性组织学分析显示，肌层静脉腔内有肿瘤性血栓形成。据报道，约有26例因心内肿瘤血栓形成而进行了心脏直视手术。对这些病例以及本文所述病例进行了回顾和分析。在本病例中，术前获得了肿瘤的全貌，并采用正中胸骨切开术（心脏切开术）和剖腹术通过一期手术切除病变。一期手术的报道很少；27例中只有8例（30%）。
