case_images: PMC10613730_01
case_images: Imaging of the tumor. The superior and inferior vena cava CTA showed an enlarged uterine as well as low-density image in the venous system and the right atrium (A-E). The red arrow indicates the mass. The three-dimensional computed tomography reconstruction of the whole path of the mass originating from the uterine and invaded into the venous system and eventually to the right atrium (F, G). (F) Back view (G). Endovascular imaging of the tumor. Red represents the mass; blue represents the blood vessel.
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case_images: The tumor extended along the veins, and the venous system shows low-density shadows ( Figures 1A-E ). Figures 1F, G ). FDG-positron emission tomography/computer tomography (PET-CT) demonstrated a maximum standardized uptake value of 14.5 confined to the uterine masses in contrast to an uptake value of 8.5 in the intravascular and intracardiac metastatic masses.
case_images: Imaging of the operation (A) and gross specimen (B).The black arrow indicates the ovarian blood vessel dilated by the tumor. (**intravascular metastatic lesion; *intracardiac metastatic lesion).
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case_images: The longest tumor segment (reaching the inferior vena cava and right atrium) was 14.5 cm ( Figures 2A, B ).
case_images: Pathological findings of the primary uterine foci and intravascular metastatic lesion. (A-C) Immunohistochemical findings of the primary uterine foci a (H&E, orig., x15). Tumor cells are positive for CD10 but negative for Desmin. Smooth muscle tissues are positive for Desmin. (B, CD10; C, Desmin; **smooth muscle component; *tumor cell component). (D-F) Immunohistochemical findings of the primary uterine foci b (H&E, orig. x20). Tumor cells are positive for ER but negative for SMA. Smooth muscle tissues are positive for SMA. (E, SMA; F, ER; **smooth muscle component; *tumor cell component). (G, H) Pathological findings of the intracardiac metastatic lesion (H&E, orig. x200). Tumor cells are positive for CD10 (H, CD10). (I) Intravascular metastatic tumor tissue (H&E, orig. x15). The black arrow indicates that the tumor tissue partially infiltrated the vein. (J, K) Cell morphology (H&E, orig. x400). Photomicrograph shows a small and uniform population of round to oval cells with little-moderate eosinophilic cytoplasm and nuclear mitotic activity 0-1/400 HPF. The black arrow indicates the spiral artery. [J, local amplification of primary lesion a (A); K, local amplification of primary lesion b (D)]. (L) Cyclin D1 (10%) staining in the primary uterine foci (H&E, orig. x400). (M) Ki-67 (40%) staining in the primary uterine foci (H&E, orig. x400). (N) Cyclin D1 (<1%) staining in metastatic lesions (H&E, orig. x400). (O) Ki-67(4%) staining in metastatic lesions (H&E, orig. x400).
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case_images: Different from ESN, the tumor tissue showed an invasive growth pattern by inserting into the surrounding smooth muscle ( Figures 3G-K ). Immunohistochemistry results showed positive expression of ER and CD10 but negative for Desmin and SMA of tumor cells( Figures 3A-F ).
case_images: The therapeutic course of our patient.
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case_images: The therapeutic course of our patient is shown in  Figures 4 .