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Intravenous Leiomyomatosis that was Difficult to Distinguish in Treatment-Resistant Thrombosis Complicated with a Large Leiomyoma: A Case Report

Yuki Yoshimura, Kentaro Nakayama, Ruriko Fukushima, Hitomi Yamashita, Tomoka Ishibashi, Masako Ishikawa, Hiroki Sasamori, Seiya Sato, Satoru Kyo

Background: Intravascular leiomyomatosis (IVL) is a rare benign tumor that grows within the veins, similar to cancer, without invading them.

Case presentation: We report the case of a 55-year-old woman who had a large leiomyoma (20 cm × 16 cm × 9 cm) and was scheduled for surgery.  Contrast-enhanced computed tomography was performed preoperatively and it revealed clots in the Inferior Vena Cava (IVC). This led to a diagnosis of deep venous thrombosis. Anticoagulation therapy was initiated, but the thrombus did not decrease in size. She was diagnosed with an organized thrombosis, and under general anesthesia which closed monitoring patients, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. During the surgery, leiomyoma moved up to the blood vessel. We diagnosed IVL based on a histopathological examination.

Conclusion: The possibility of IVL should be amply considered when suspecting treatment-resistant thrombosis associated with a large leiomyoma.