Intravenous leiomyomatosis: report of two cases and strategy for surgical resection

Intravenous leiomyomatosis is a rare smooth muscle tumour that arises from the myometrium and grows into the extrauterine venous system. It typically can extend into the vena cava inferior and even the cardiac chambers. This can lead to life threatening obstruction of cardiac valves. The only effective treatment is surgical resection. However, no clear guidelines with respect to surgical approach and further strategy are available in the literature. Especially the indications for a simultaneous thoracic approach and for either one-stage or two-stage approach are unclear. On the basis of two cases of intravenous leiomyomatosis with different levels of intracaval extension of the tumour, this article discusses a useful strategy for planning surgical resection, taking into account tumour characteristics and different levels of intracaval extension.