case_images: PMC11002323_01
case_images: IVL radiographic image. (A) Transvaginal ultrasound was performed 3 days before surgery. (B) Axial CT scan of the abdomen showing a large pelvic mass. (C) MRI images showing a large mass of uterine origin that was initially considered a uterine sarcoma. CT, computed tomography; IVL, intravascular leiomyoma; MRI, magnetic resonance imaging.
case_images: whr.2023.0091_figure1.jpg
case_images: PMC11002323_01_whr.2023.0091_figure1.jpg
case_images: f1
case_images: There were no significant changes in the bilateral ovaries (Fig. 1A). A computed tomography (CT) scan of the whole abdomen revealed a large soft tissue mass in the lower abdomen and pelvic cavity 100 x 170 mm in size with uneven density, strip calcification foci and flake low-density shadows that were connected to the uterus below (Fig. 1B). A cystic lesion in the right adnexal area with a size of 22 x 18 mm was found (Fig. 1C).
case_images: (A) Hysterectomy and double adnexectomy specimens. (B) The intravascular tumour almost entirely filled the lumens of the preexisting veins, as shown by H&E staining. H&E, haematoxylin and eosin.
case_images: whr.2023.0091_figure2.jpg
case_images: PMC11002323_01_whr.2023.0091_figure2.jpg
case_images: f2
case_images: During macroscopic pathologic examination, the cut surface of the uterus showed ill-defined intramural nodules in the tumor (Fig. 2A). Smooth muscle tissue could also be observed in the fallopian tubes and ovarian veins (Fig. 2B).
case_images: Histopathology of IVL. Immunohistochemical staining for calponin and smooth muscle actin demonstrated the myogenic structure of the lesion (A, B). The endothelium of the blood vessels and the surface of the tumour are positive for CD31 and factor VIII-related antigen (C, D). The IVL tumour was consistently positive for ER (E) and PR (F). The original magnifications were all 100 x . ER, estrogen receptor; PR, progesterone receptor.
case_images: whr.2023.0091_figure3.jpg
case_images: PMC11002323_01_whr.2023.0091_figure3.jpg
case_images: f3
case_images: On immunohistochemistry, the tumor cells exhibited strong staining for calponin and smooth muscle actin (Figure 3A, B). Immunohistochemical evaluation revealed that the area of the tumor that had developed intravascularly was positive for estrogen receptor and progesterone receptor (Figure 3E, F).