{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:05:59Z","timestamp":1769515559337,"version":"3.49.0"},"reference-count":22,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,29]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>Intravascular leiomyomatosis is a rare, benign tumour of myometrial smooth muscle. Despite being non-invasive, these tumours can proliferate aggressively within vascular structures including pelvic vessels, the vena cava and the heart. We discuss a 77-year-old woman presenting with a 9\u2009cm uterine mass extending into the right adnexa and ovarian vein. Following hysteroscopic biopsy, palliative radical surgical resection was performed for suspected stage IV leiomyosarcoma. Tumour extension into the pelvic sidewall and obturator fossa indicated a modified laterally extended endopelvic resection combined with skeletonisation and preservation of the pelvic neurovasculature, ultimately providing a curative procedure with minimal functional neurological morbidity. We present this unusual case to assist in the development of a consensus for optimal case management where formal guidelines are not yet available. We summarise current understanding of intravascular leiomyomatosis and highlight the value of advanced surgical techniques using knowledge of complex ontogenetic and pelvic neuroanatomy in its management.<\/jats:p>","DOI":"10.1136\/bcr-2021-244774","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T12:46:43Z","timestamp":1631796403000},"page":"e244774","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Atypical presentation of intravascular leiomyomatosis mimicking advanced uterine sarcoma: modified laterally extended endopelvic resection with preservation of pelvic neural structures"],"prefix":"10.1136","volume":"14","author":[{"given":"Philip","family":"Cowie","sequence":"first","affiliation":[{"name":"Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7407-8247","authenticated-orcid":false,"given":"Sarah","family":"Smyth","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3293-5321","authenticated-orcid":false,"given":"Hooman","family":"Soleymani majd","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"2025082711552676000_14.9.e244774.1","first-page":"932","article-title":"Intravenous leiomyomatosis of the uterus","volume":"23 Pt 2","author":"Clement","year":"1988","journal-title":"Pathol Annu"},{"key":"2025082711552676000_14.9.e244774.2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ejogrb.2013.09.031","article-title":"Update on intravenous leiomyomatosis: report of five patients and literature review","volume":"171","author":"Vald\u00e9s Devesa","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025082711552676000_14.9.e244774.3","first-page":"362","article-title":"Estrogen and progesterone expression of vessel walls with intravascular leiomyomatosis; discussion of histogenesis","volume":"25","author":"Kir","year":"2004","journal-title":"Eur J Gynaecol Oncol"},{"key":"2025082711552676000_14.9.e244774.4","first-page":"030006051989688","article-title":"Intravenous leiomyomatosis: case series and review of the literature","volume":"48","author":"Liu","year":"2020","journal-title":"J Int Med Res"},{"key":"2025082711552676000_14.9.e244774.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2020\/9758302","article-title":"Intravenous leiomyomatosis of the uterus: a retrospective single-center study in 14 cases","volume":"2020","author":"Su","year":"2020","journal-title":"Biomed Res Int"},{"key":"2025082711552676000_14.9.e244774.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.06.037"},{"key":"2025082711552676000_14.9.e244774.7","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1038\/modpathol.2016.36","article-title":"Intravenous leiomyomatosis: an unusual intermediate between benign and malignant uterine smooth muscle tumors","volume":"29","author":"Ordulu","year":"2016","journal-title":"Mod Pathol"},{"key":"2025082711552676000_14.9.e244774.8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.3109\/00016348909028675","article-title":"Intravenous leiomyomatosis","volume":"68","author":"Konrad","year":"1989","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025082711552676000_14.9.e244774.9","unstructured":"Sizenfrey A . 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