PMC9799196_01
Computed tomography of the chest, abdomen, and pelvis with intravenous contrast. A mixed solid and cystic exophytic mass ~13.7 x 13.6 x 12.1 cm arising from the pelvis (white arrow marking the uterus) with a cystic component (*), measuring ~24.8 x 12.0 x 16.4 cm, extending into the epigastric region. (A) Coronal view. (B) Sagittal view. A non-occlusive filing defect in the inferior vena cava (blue arrow) extending into the right atrium (red arrow).
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Computed tomography imaging of the chest, abdomen, and pelvis with intravenous contrast (Figure 1) revealed a heterogeneous mixed solid and cystic mass arising from the fundal endometrium with a large cystic component extending into the epigastric region. Computed tomography imaging also revealed a filling defect extending from the right ovarian vein into the inferior vena cava (IVC), RA, and right ventricle (RV) (Figure 1B).
Cardiac magnetic resonance of right-sided heart mass. Cardiac magnetic resonance with contrast and velocity flow mapping. (A) Four-chamber view showing a 3.5 x 1.8 cm mass (red arrow) in the right atrium. (B). Delayed gadolinium imaging showing homogeneous late enhancement of right atrium mass. (C) T1-weighted imaging showing isointense right atrium mass compared with myocardium (blue arrow). (D) T2-weighted imaging showing hyperintense right atrium mass when compared with myocardium.
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Table 2) was performed. Consistent with the TTE, a 3.8 x 1.5 cm mobile mass in the RA was observed projecting into the RV (Supplementary material online, Video S2). The mass was isointense on T1-weighted images, hyperintense on T2-weighed images, and homogenous on delayed gadolinium enhancement (Figure 2B-D).
Gross surgical specimens and histology. The entire mass was resected and sent to pathology for analysis. (A) Intraoperative image showing mixed solid and cystic mass in the pelvic region. (B) Tumour cast excised from the inferior vena cava and right heart chambers. (C) Representative H&E slide showing smooth muscle cells without atypia. (D) Resected samples strongly expressed oestrogen receptor.
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The procedure was well tolerated, and the entire mass (Figure 3AandB) was removed without complication. Resected samples stained strongly for the smooth muscle cell makers desmin and caldesmon, and cytology showed no atypia (Figure 3C), confirming the diagnosis of IVL. Consistent with previous reports, samples from our patient strongly expressed oestrogen (Figure 3D) and progesterone receptors.