Korean J Radiol.  2016 Apr;17(2):289-294. 10.3348/kjr.2016.17.2.289.

Uterine Intravenous Leiomyomatosis with Intracardiac Extension and Pulmonary Benign Metastases on FDG PET/CT: A Case Report

• Wang HC
• Wang YB
• Chen XH
• Cui LL

• KMID: 2360216
• DOI: http://doi.org/10.3348/kjr.2016.17.2.289

Abstract

A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.

Keyword

Uterine intravenous leiomyomatosis; Heart tumor; Lung metastases; FDG PET/CT

MeSH Terms

Female
Fluorodeoxyglucose F18/chemistry
Humans
Leiomyoma/pathology/radiography
Leiomyomatosis/pathology/*radiography
Lung Neoplasms/radiography/*secondary
Magnetic Resonance Imaging
Middle Aged
Positron-Emission Tomography
Tomography, X-Ray Computed
Uterine Neoplasms/pathology/radiography
Vena Cava, Inferior/pathology
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 48-year-old woman with uterine intravenous leiomyomatosis accompanied by intracardiac extension and pulmonary benign metastases. A. MIP image of FDG PET, and transverse FDG PET/CT images of abdomen showed physiological FDG uptake in colon and endometrium (arrows), mild FDG uptake in lobulated, aggressive occupying lesion in abdominal and pelvic cavity (SUVmax = 1.6). FDG PET/CT = fluorodeoxyglucose positron emission tomography/computed tomography, MIP = maximum intensity projection, SUVmax = maximum standardized uptake value. B. Transverse FDG PET/CT images of lung demonstrated multiple nodules in bilateral lungs without hypermetabolic foci (SUVmax = 0.5–1.0) (arrows). C. Cardiac transverse FDG PET/CT images revealed hypodense lesion with mild FDG uptake in right ventricle (SUVmax = 2.1) (arrows). FDG PET/CT = fluorodeoxyglucose positron emission tomography/computed tomography, SUVmax = maximum standardized uptake value. D. Transverse contrast enhanced T1-weighted MRI showed intravascular filling defects in both enlarged ovarian veins (arrows), also in IVC extending into right atrium (E, arrow). F-H. MR white-blood sequence indicated three oval masses in right cardiac ventricle, of which, largest mass extended into right ventricular outflow tract (arrows). I. Pathological appearances of abdominal and pulmonary lesions (hematoxylin-eosin, original magnification, x 20) showed interlaced bundles of spindle cells with homogeneous size, oval nuclei, eosinophilic cytoplasm, rare mitotic figures, and decorated by several thick-walled small blood vessels, which were consistent with features of leiomyoma. IVC = inferior vena cava

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