Myoma filled the uterus and grew wildly along the veins! Experts from Renji Hospital took turns to "disarm" the tumor in 8 hours

There are countless uterine fibroids! What's even crazier is that uterine fibroids are extremely "penetrating". They take root and sprout from the uterus and "grow wildly", "going upstream" along the inferior vena cava, spreading the "seeds" of fibroids all the way, involving many important veins! This rare disease happened to 63-year-old Ms. Zhou.

Ms. Zhou started to feel something was wrong a year ago. She found a lump in her abdomen, but she didn't pay much attention to it. The lump grew bigger and bigger, and it wasn't until early June this year that Ms. Zhou went to see a doctor.

The local hospital considered that Ms. Zhou had multiple uterine fibroids. Although uterine fibroids are the most common benign tumors in women, the fibroids filled the pelvic cavity and the uterus was twice the size of a normal uterus. Ms. Zhou looked like she was five months pregnant. The local hospital considered the operation difficult and recommended her to a large hospital in Shanghai for further treatment.

Ms. Zhou came to the Department of Gynecological Oncology of Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine and completed relevant examinations. However, the CT examination results were not optimistic: Ms. Zhou's uterus was full of fibroids, and there were filling defects in many large veins in the pelvic and abdominal cavities.

Combined with the medical history, Liu Kaijiang, director of the Department of Gynecological Oncology, diagnosed it as "vascular leiomyoma", a disease of abnormal proliferation of smooth muscle cells in blood vessels. The vascular leiomyoma in Ms. Zhou's body was indeed growing wildly, growing upward through the bilateral internal iliac veins and along the common iliac veins into the inferior vena cava, and had reached the level of the renal veins. After carefully reading the film, it was found that part of the tumor grew through the left reproductive blood vessels and spread into the left renal vein.

Liu Kaijiang instructed to complete all examinations as soon as possible, evaluate the tumor status, and formulate a treatment plan.

On June 19, experts from the Department of Gynecological Oncology, Department of Urology, and Department of Anesthesiology stood together at the operating table, fighting against the densely packed fibroids.

Zhou Jie, deputy chief physician of the Department of Anesthesiology of Renji Hospital, successfully intubated the patient after completing the preoperative evaluation. The operation began with the gynecological oncology team led by Liu Kaijiang under the protection of the Department of Anesthesiology.

After going into the abdomen layer by layer, Liu Kaijiang saw that the uterus had completely lost its normal shape, and the uterine and parauterine veins were tortuous and thickened. With each cut, the vascular leiomyoma, like a white earthworm, gushed out from the broken end of the vein. "The biggest risk in vascular leiomyoma surgery is that once the tumor thrombus in the blood vessel breaks off and causes embolism, the mortality rate is extremely high." After carefully identifying the anatomical structure, Liu Kaijiang processed the corresponding blood vessels in advance according to the surgical design repeatedly deduced before the operation, and neatly completed the total hysterectomy and bilateral adnexectomy.

(The removed uterus was full of fibroids and no longer had its normal shape)

After the hysterectomy, the team led by Huang Jiwei, deputy chief physician of the Urology Department, took over. The tumor thrombus was present in the inferior vena cava and the left reproductive blood vessels all the way to the left renal vein, involving many important veins.

Huang Jiwei carefully dissected the abdominal aorta, inferior vena cava, bilateral renal arteries and veins, bilateral internal iliac veins and other related blood vessels, and used B-ultrasound to determine the location and range of the tumor thrombus. The vascular clamp temporarily blocked the blood supply around the vein where the tumor thrombus was located. As the vascular clamp clamped the inferior vena cava, the circulating nurse pressed the timer, which meant that the surgeon had to complete a series of operations within a limited time, including cutting the blood vessels, completely removing the tumor thrombus, and tightly suturing the blood vessel wall. Huang Jiwei took the blade and cut open the wall of the inferior vena cava, quickly extracting the tumor in the exposed blood vessel, and completing the task in one go.

(A tumor thrombus in a blood vessel)

Although the larger blood vessels around the tumor had been blocked, the bleeding at the incision of the inferior vena cava still made the doctors on the scene dare not relax their tense nerves. After removing the thrombus, the wall of the inferior vena cava was carefully sutured. Huang Jiwei immediately removed the tumor thrombus in the left renal vein and sutured the vein wall in the same way. After loosening the vascular clamp, the vascular wound was checked for bleeding. B-ultrasound examination of the relevant veins also showed no residual tumor, and everyone breathed a sigh of relief.

The operation lasted 8 hours and ended successfully. The next day, Ms. Zhou was successfully extubated and her vital signs were stable.

Renji Hospital revealed that Ms. Zhou is currently recovering well, is able to walk around, and has been discharged smoothly.

Liu Kaijiang said that uterine angiomyoma is a rare benign tumor originating from the smooth muscle of uterine blood vessels. Due to its special growth pattern and location, if not treated in time, the tumor will grow along the blood vessels all the way to the right atrium. And once the tumor falls off, it will seriously threaten the patient's life.

The disease is difficult to diagnose and there is no effective drug treatment. Radical surgery is an effective treatment for the disease, but the operation is difficult, the incidence of intraoperative complications is high, and it requires multidisciplinary collaboration.

Source: Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine