Abstract
RATIONALE: Intravascular/intravenous leiomyomatosis (IVL) is a rare benign smooth muscle cell tumor with malignant biological behavior. The early diagnosis of IVL is challenging, and the range of treatment options is extensive. PATIENT CONCERNS: Herein, we present 2 cases of IVL that present markedly different clinical presentations. These cases underscore the importance of vigilance in the diagnosis of IVL. A further objective of this study is to demonstrate the similarities and differences in treatment modalities. Patient 1 was registered for lower abdominal discomfort and a palpable pelvic mass, with a high preoperative suspicion of IVL. Patient 2 was characterized by severe vaginal bleeding during menstruation, accompanied by a palpable uterine mass, and an initial diagnosis of uterine adenomyosis or fibroids, with suspicion of IVL. DIAGNOSES: Both patients' diagnoses were confirmed as IVL by histopathology. INTERVENTIONS: Removal of the uterine lesion combined with bilateral salpingo-oophorectomy was performed in the former case, whereas total hysterectomy and bilateral salpingo-oophorectomy were performed in the latter case. Both were treated postoperatively with Qiu empirical formula, a traditional Chinese medicine herbal decoction. OUTCOMES: No recurrence was observed in either patient. LESSONS: In the 2 cases examined in this study, following initial evaluation by imaging and complete resection of the lesion by surgical treatment initially, the patients demonstrated a more favorable prognosis following the application of herbal preparations in the long-term postoperative follow-up period. Our work provides additional information for clinicians to further study and better understand specific types of leiomyosarcoma.