Uterine Intravenous Leiomyomatosis with Cardiac Extension: Radiologic Assessment with Surgical and Pathologic Correlation

Figure 6

Radiologic-pathologic correlation. (A) The level of the origin of the extrauterine lesion. (A-a) AC-CT image revealed that the origin of the continuous mass extending into the IVC was a small nodule (arrow) on the surface of the uterine tumor (arrowheads); this was determined by referring to MPR images (Figure 2(a) arrows). (A-b) On a photomicrograph at the same level as the AC-CT image, the nodule could be identified as a small nodule of lipoleiomyoma (arrows) on the surface of the uterine lipoleiomyoma (arrowheads). (A-c) No vein wall structure was found around the nodule. (B) The level of the right ovarian vein. (B-a) AC-CT indicated the presence of plexiform arteries along the route of the right ovarian vein (arrow). (B-b) A photomicrograph at the same level showed a large number of vessels (arrowheads) surrounding a bundle of vessels with a small amount of smooth muscle cells (arrow). There was no vein wall structure around smooth muscle cells and hematoxylin-eosin (HE) staining showed no evidence of the tumor component. (B-c) The nuclei of smooth muscle cells stained positive for ER and PR (not shown), which indicated that they were a continuous part of the uterine tumor, but there was no evidence of an intravenous component. (C) The level of the IVC. (C-a) The intracardiac and intracaval components of the tumor appeared as a cord-like mass composed of just a bundle of arteries on the AC-CT image (arrow). (C-b) AC-CT image showed three arteries within the tumor (arrows). (C-c) Histologic examination revealed those components were composed of degenerated smooth muscle cells including several large vessels (arrows). (C-d) The smooth muscle cells stained positive for ER and PR (not shown).