IV Leiomyomatosis on FDG PET/CT

Area of Science:

• Vascular Surgery
• Oncology
• Pathology

Background:

• Uterine leiomyomas are common benign tumors, but can rarely present with unusual vascular involvement.
• Pelvic masses can cause significant venous obstruction, leading to lower extremity edema.

Observation:

• A 48-year-old woman presented with unilateral leg swelling due to a mass extending from the iliac veins into the inferior vena cava.
• Imaging studies, including CT and PET/CT, suggested a possible malignancy due to the mass's appearance and increased FDG uptake.

Findings:

• Histopathological examination definitively diagnosed the mass as intravascular leiomyomatosis, a rare benign condition.
• The PET/CT scan showed increased FDG activity, which can be misleading in differentiating benign from malignant vascular masses.

Implications:

• Intravascular leiomyomatosis should be considered in the differential diagnosis of pelvic masses causing venous obstruction.
• Histopathological analysis is crucial for accurate diagnosis and to avoid misclassification as malignancy.
• Understanding the imaging characteristics of intravascular leiomyomatosis is important for appropriate patient management.