Intravascular Lipoleiomyoma With Expansion Into the Right Atrium and Subsequent Debulking Surgery

Figures

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  Figure 1. Intracardiac Tumor Imaging With Echocardiography, Computed Tomography, and Magnetic Resonance Imaging (A) Echocardiographic 4-chamber view with a round mass in the area of the right atrium that measured 28 mm × 27 mm. (B) Echocardiographic subxiphoid view with a pronounced mass extending from the inferior vena cava into the right atrium. (C) Axial T1-weighted gradient echo sequence with fat suppression, 7 minutes post contrast medium administration, shows the tumor in the right iliac vein. (D) Electrocardiogram-triggered heart computed tomography, axial imaging, slice thickness 1 mm, shows a smoothly marginated, approximately 30 mm × 27 mm mass located centrally in the right atrium, without contact with the intra-atrial septum. (E) Venous computed tomography, coronal reformation from 1-mm slices, shows the long course of the tumor extending from the right common iliac vein through the inferior vena cava into the right side of the heart.

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  Figure 2. Macroscopic and Microscopic Views (A) The right iliac vein. (B) The vein lumen is completely filled by the tumor. (C) A vascular prosthesis was sutured after resection (absorbable hemostasis around the graft). (D) Low-power view of intravascular lipoleiomyomatosis showing an admixture of fat vacuoles and eosinophilic smooth muscle cells; note the muscular venous wall on the left. (E) Higher magnification of the tumor showing biphasic differentiation of the tumor cells (fat and smooth muscle cells). (F) Diffuse and strong cytoplasmic expression of h-caldesmon in the smooth muscle tumor cells. (G) Strong nuclear expression of progesterone receptor in the tumor cells.