靜脈內平滑肌瘤伴隨心臟侵犯

Intravenous Leiomyomatosis with Cardiac Extension

靜脈內平滑肌瘤是相當罕見的良性腫瘤，可能源自於子宮肌瘤或子宮內的血管壁，其發展緩慢，但可能經由下腔靜脈侵入右心，導致心臟衰竭、昏厥、甚至猝死。正因其罕見，所以可能會被誤診成其他疾病。此個案報告中，我們報告了一位51歲有子宮肌瘤病史的女性，因體檢意外發現右心房腫瘤，初始診斷為黏液瘤。於手術中發現腫瘤是由下腔靜脈侵入到右心房，電腦斷層顯示，高血管性的腫瘤從子宮經由右側卵巢靜脈，上行至下腔靜脈。病理組織學的最終報告為靜脈內平滑肌瘤。此個案報告顯示，當發現右心腫瘤時，需詳細的詢問病史，並仔細的檢查下腔靜脈。有子宮肌瘤病史的中年女性合併右心腫瘤，需考慮靜脈內平滑肌瘤的可能性。

Intravenous leiomyomatosis is a rare benign tumor with slow growth. Smooth muscle tumors may originate from either a uterine myoma or from the wall of a uterine vessel. Intravenous leiomyomatosis may grow in the inferior vena cava and extend into right heart in rare cases, leading to heart failure, syncope and sudden death. Due to its rarity, misdiagnosis is common. In this case report, we describe a 51-year-old woman with a history of uterine myoma. A right atrial tumor was found unexpectedly during echocardiography when undergoing routine health examination. Our first diagnosis was myxoma. However, the tumor was found extending from the inferior vena cava during surgical intervention. The computed tomography showed a hypervascular tumor, originated from the uterine, extended from the right ovarian vein to the suprarenal inferior vena cava. The final pathohistological report was intravenous leiomyomatosis. The present case report illustrated a thorough history taking and a careful examination of the inferior vena cava are necessary when finding a right heart tumor on echocardiography. Intravenous leiomyomatosis must be considered if finding a right heart tumor in a middle-aged woman with a history of uterine myoma.