case_images: PMC3248607_01
case_images: (A) A preoperative sagittal computed tomography (CT) scan showing a mass (leiomyoma) extending from the right internal iliac vein to the right atrium. Figures A-1 to A-7 show the transverse CT scans of the areas indicated in A. (A-1 and A-2) The intracardiac tumor. (A-3 to A-4) The intracaval tumor. Note that both kidneys presented with multiple cysts. (A-5) The severely dilated inferior vena cava (11 cm). (A-6) The multilobulated pelvic tumor with intense vascularization. (A-7) The intrailiac tumor. (B-H) The postoperative CT scans, showing absence of the tumor and a normal-diameter inferior vena cava. I-HVC, intrahepatic vena cava; IVC, inferior vena cava; RA, right atrium; RHC, right heart chambers; RV, right ventricle; yellow arrow, tumor localization; black arrow, vessel lumen.
case_images: cln-67-01-83-g001.jpg
case_images: PMC3248607_01_cln-67-01-83-g001.jpg
case_images: f1-cln_67p83
case_images: A thoracoabdominal computed tomography scan (Figure 1A) revealed a mass extending from the right internal iliac vein to the right atrium; however, it was unclear whether this mass represented a thrombus or a tumor. Multiple cysts were observed in both kidneys (Figure 1A-4). The inferior vena cava was severely dilated (11 cm) (Figure 1A-5). The postoperative course was uneventful, and a control computed tomography scan revealed no evidence of tumor (Figure 1B-H).
case_images: (A) The right atrium and the superior and inferior vena cava were completely exposed through a right thoracophrenolaparotomy. (B) The pericardium was opened to access and cannulate the right atrium. (C) The intra-atrial extension of the tumor was removed through a superior cava incision located 3 cm proximal to the atrium. Note that the right atrium was not opened to achieve tumor exposure. (D) The intracaval extension of the tumor was completely detached from the vessel wall. (E) The specimen morphology. The excised tumor measured 31 cm in length and had no thrombi or areas of friable tissue. (F) A histological examination of a hematoxylin and eosin-stained tissue section (200X). The smooth muscle cells were predominantly organized into fascicles and occasionally into a plexiform pattern. The cells showed no abnormal mitotic activity, atypia, or necrosis, supporting the diagnosis of intravascular leiomyoma. IVC, inferior vena cava; RA, right atrium; RK, right kidney; SVC, superior vena cava.
case_images: cln-67-01-83-g002.jpg
case_images: PMC3248607_01_cln-67-01-83-g002.jpg
case_images: f2-cln_67p83
case_images: Multiple cysts were observed in both kidneys (Figure 1A-4). The inferior vena cava was severely dilated (11 cm) (Figure 1A-5). The superior and inferior vena cava, the right atrium, and the two renal, iliac, and suprahepatic veins were exposed via a right thoracophrenolaparotomy in the fifth intercostal space (Figure 2A), after which the pericardium was opened with an inverted T-shaped incision (Figure 2B). In the first step, the intra-atrial extension of the mass was removed through a superior vena cava incision located 3 cm proximal to the closed right atrium (Figure 2C). In the second step, the intravascular extension of the mass was detached and removed through an inferior cava venotomy (Figure 2D) that extended caudally towards the iliac bifurcation. The excised mass measured approximately 31 cm in length (Figure 2E) and had no thrombi or areas of friable tissue. The histological examination revealed a benign tumor compatible with an intravascular leiomyoma (Figure 2F).