What is the clinical evidence from this study?

Study design: Case Report. Population: Uterine leiomyosarcoma with intravenous extension (n=1). Intervention: Neoadjuvant chemoradiotherapy, total hysterectomy, and emergency beating-heart thrombectomy.

What question did this study set out to answer?

This case examines the rare presentation of uterine leiomyosarcoma with intravascular extension presenting as thromboembolism.

May 16, 2026Open Access

Intravascular extension of uterine sarcoma: A rare presentation mimicking venous thromboembolism

Key Result

A 57-year-old woman with uterine leiomyosarcoma developed a massive tumor thrombus extending into the right atrium and succumbed to refractory cardiogenic shock despite emergency thrombectomy.

Key Points

This case examines the rare presentation of uterine leiomyosarcoma with intravascular extension presenting as thromboembolism.
Initial MRI followed by neoadjuvant chemoradiotherapy and total hysterectomy
Emergency echocardiography and CT angiography post-symptom onset
Multi-parametric imaging techniques for diagnosis
Identified a massive tumor thrombus extending from the inferior vena cava to the right atrium
Complicated by bilateral lobar pulmonary embolism
Patient experienced refractory cardiogenic shock despite aggressive surgical intervention

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 57-year-old postmenopausal woman with a voluminous pelvic mass identified as high-grade uterine leiomyosarcoma with extensive local invasion and tumor thrombosis of the left ovarian vein.

Intervention

Neoadjuvant chemoradiotherapy, total hysterectomy, followed by emergency beating-heart thrombectomy and intensive care support for massive tumor thrombus extending into the right atrium and bilateral lobar pulmonary embolism.

Malignant intravenous leiomyosarcomatosis can mimic venous thromboembolism, requiring systematic vascular screening with MRI and CT angiography in aggressive uterine malignancies to prevent fatal embolic events.

Abstract

Uterine leiomyosarcoma (ULMS) is a highly aggressive mesenchymal malignancy. While hematogenous spread is common, malignant intravenous leiomyosarcomatosis (IVLS) with extension into the heart is an exceptional and life-threatening phenomenon that presents significant diagnostic and therapeutic challenges. A 57-year-old postmenopausal woman presented with a voluminous pelvic mass. Initial MRI identified a high-grade ULMS with extensive local invasion and tumor thrombosis of the left ovarian vein. Following neoadjuvant chemoradiotherapy and total hysterectomy, the patient developed acute respiratory distress. Emergency echocardiography and CT angiography revealed a massive tumor thrombus extending from the iliac veins and inferior vena cava (IVC) into the right atrium, complicated by bilateral lobar pulmonary embolism. Despite an emergency beating-heart thrombectomy and intensive care support, the patient succumbed to refractory cardiogenic shock. This case underscores the critical role of multi-parametric MRI and CT angiography in identifying malignant intravascular extension. Differentiating tumor thrombi from bland venous thromboembolism is essential, as IVLS requires aggressive, multidisciplinary surgical management. Systematic vascular screening should be mandatory in cases of aggressive uterine malignancies to prevent fatal embolic events.