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Title: Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism

Abstract

We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism.

Authors:
; ;  [1];  [2]
  1. Massachusetts General Hospital, Department of Radiology (United States)
  2. Massachusetts General Hospital, Department of Pathology (United States)
Publication Date:
OSTI Identifier:
21091057
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 30; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-006-0118-4; Copyright (c) 2007 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; EMBOLI; NEOPLASMS; UTERUS; VEINS; WOMEN

Citation Formats

McDonald, Douglas K., Kalva, Sanjeeva P., E-mail: sanjeevakalva@gmail.com, Fan, C.-M., and Vasilyev, Aleksandr. Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism. United States: N. p., 2007. Web. doi:10.1007/S00270-006-0118-4.
McDonald, Douglas K., Kalva, Sanjeeva P., E-mail: sanjeevakalva@gmail.com, Fan, C.-M., & Vasilyev, Aleksandr. Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism. United States. doi:10.1007/S00270-006-0118-4.
McDonald, Douglas K., Kalva, Sanjeeva P., E-mail: sanjeevakalva@gmail.com, Fan, C.-M., and Vasilyev, Aleksandr. Thu . "Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism". United States. doi:10.1007/S00270-006-0118-4.
@article{osti_21091057,
title = {Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism},
author = {McDonald, Douglas K. and Kalva, Sanjeeva P., E-mail: sanjeevakalva@gmail.com and Fan, C.-M. and Vasilyev, Aleksandr},
abstractNote = {We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism.},
doi = {10.1007/S00270-006-0118-4},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 30,
place = {United States},
year = {Thu Feb 15 00:00:00 EST 2007},
month = {Thu Feb 15 00:00:00 EST 2007}
}
  • To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1,493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism. Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans. Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonarymore » embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings.« less
  • The authors attempt to demonstrate those circumstances for which perfusion scintigraphy, by itself, or in combination with ventilation scintiscanning, offers the best adjunctive information in excluding or confirming the presence of pulmonary embolism. They then identify those circumstances in which scintiscanning does not or cannot contribute significantly to the medical decision-making process. In these cases, the use of pulmonary angiography or possibly peripheral venography is not only recommended but, if warranted clinically, is absolutely necessary.
  • The use of pulmonary angiography as related to ventilation-perfusion scintigraphy was studied at two teaching hospitals in 600 patients clinically suspected of having pulmonary embolism, using a combined prospective-retrospective approach. Sixty patients underwent angiography, 30 in each institution. A minority of patients in each scintigraphic diagnostic category underwent angiography, but the scintigraphic diagnosis had a major impact on the frequency of requests for angiography. Inconclusive scintigraphy was the principal reason for requesting angiography, although nearly half of patients in whom scintigraphic assessment was indecisive were managed without further diagnostic measures. Few patients in the low-probability and high-probability scintigraphic categories receivedmore » angiography. This study also indicates that a substantial patient selection bias may exist in series that correlate scintigraphic and angiographic results.« less
  • The difficulties in diagnosing pulmonary embolism are discussed with emphasis on the role of chronic obstructive pulmonary disease in increasing the difficulties. Perfusion lung scanning is a major screening test for pulmonary embolism. The importance of a multiple view scan is emphasized. Chronic obstructive pulmonary disease is the most common cause of nonembolic perfusion defects. Pulmonary angiography is usually required for diagnostic confirmation. Ventilation--perfusion studies employing $sup 133$Xe have been reported to show characteristic changes indicative of pulmonary embolism in patients with chronic obstructive pulmonary disease. (HLW)