Multidisciplinary Treatment of intravenous leiomyomatosis with inferior vena cava or intracardiac extension

Background This study provides a concise review of the multidisciplinary management of intravenous leiomyomatosis (IVL) with inferior vena cava or intracardiac extension, based on cases from a tertiary teaching hospital in China. Methods We retrospectively analyzed nine patients diagnosed with intravenous leiomyomatosis （ IVL ） extending to the inferior vena cava or cardiac chambers between January 2015 and February 2025. Data included patient demographics, imaging findings, multidisciplinary collaboration, surgical details, and follow-up outcomes. Results Most patients with intravenous leiomyomatosis （ IVL ） presented with nonspecific symptoms; 77.78% had a history of uterine leiomyoma, and 55.56% had undergone myomectomy or hysterectomy. Key imaging modalities included Computed Tomography venography, echocardiography, pelvic MRI, and pelvic ultrasound. Surgery was the primary treatment: eight patients underwent single-stage surgery, one had two-stage surgery (1/9). Six patients presented with lesions extending into the cardiac chambers (6/9),Of these, three underwent combined inferior vena cava and cardiac incision surgery, while the remaining three had tumors extracted solely via an inferior vena cava incision. Intraoperative transesophageal echocardiography was utilized for real-time monitoring to ensure complete tumor resection. Intraoperative blood loss ranged from 400 to 5000 mL (median: 1200 mL, interquartile range: 3075mL); six patients required allogeneic transfusion. No postoperative complications occurred. During the follow-up period, four patients experienced recurrence and all underwent reoperation. Conclusion Intravenous leiomyomatosis (IVL) with inferior vena cava or intracardiac extension is complex and requires multidisciplinary management.Computed Tomography venography effectively delineates intravascular lesions,and intraoperative transesophageal echocardiography provides real-time monitoring. Complete tumor resection and oophorectomy are critical for preventing recurrence.