The treatment of intravascular leiomyomatosis with different clinical manifestations: Two case reports

Intravascular/intravenous leiomyomatosis (IVL) is a rare benign smooth muscle cell tumor with malignant biological behavior. The early diagnosis of IVL is challenging, and the range of treatment options is extensive.

Herein, we present 2 cases of IVL that present markedly different clinical presentations. These cases underscore the importance of vigilance in the diagnosis of IVL. A further objective of this study is to demonstrate the similarities and differences in treatment modalities. Patient 1 was registered for lower abdominal discomfort and a palpable pelvic mass, with a high preoperative suspicion of IVL. Patient 2 was characterized by severe vaginal bleeding during menstruation, accompanied by a palpable uterine mass, and an initial diagnosis of uterine adenomyosis or fibroids, with suspicion of IVL.

Both patients' diagnoses were confirmed as IVL by histopathology.

Removal of the uterine lesion combined with bilateral salpingo-oophorectomy was performed in the former case, whereas total hysterectomy and bilateral salpingo-oophorectomy were performed in the latter case. Both were treated postoperatively with Qiu empirical formula, a traditional Chinese medicine herbal decoction.

No recurrence was observed in either patient.

In the 2 cases examined in this study, following initial evaluation by imaging and complete resection of the lesion by surgical treatment initially, the patients demonstrated a more favorable prognosis following the application of herbal preparations in the long-term postoperative follow-up period. Our work provides additional information for clinicians to further study and better understand specific types of leiomyosarcoma.