Management of intravenous leiomyomatosis: a case report illustrating two distinct surgical approaches
Bibliographic record
Abstract
Intravenous leiomyomatosis (IVL) is a benign smooth muscle growth originating in the uterus that extends into the lumen of venous or lymphatic vessels beyond the myoma. The tumour may enter the inferior vena cava (IVC) or the heart. For IVL with cardiac involvement, two distinct surgical approaches may be considered. The conventional approach involves concurrent intracardiac tumour resection via sternotomy, and resection of the intrabdominal/pelvic tumour by laparotomy, incision into the IVC, and a hysterectomy. Alternatively, an abdominal-only approach allows complete resection of the cardiac, abdominal, and pelvic portions of the IVL through IVC incision and hysterectomy. Considerations for surgical timing include a single-stage procedure, where all tumour components are addressed in one operation, or two-stage procedures, where cardiac and abdominal/pelvic components are resected in separate operations. Both approaches carry specific risks and benefits for the surgical course and patient recovery. We report two cases of patients presenting with symptomatic IVL. Patient A underwent a single-stage abdominal-only approach, including tumour removal from the IVC and hysterectomy, while Patient B underwent a two-stage surgical course involving initial intracardiac tumour resection via sternotomy, followed by a delayed subsequent abdominal tumour resection. We discuss the clinical decision-making process, benefits, and risks of both approaches, as well as preoperative and postoperative management considerations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".