Intravascular Lipoleiomyoma With Expansion Into the Right Atrium and Subsequent Debulking Surgery

Backround: Lipoleiomyomas are rare, benign tumors combining smooth muscle and adipose tissue, most commonly found in the uterus. Case Summary: A 61-year-old woman with a history of surgical treatment of uterine leiomyoma presented with syncopal episodes. Echocardiography revealed masses in the right atrium that led to urgent partial resection of a 10-cm tumor originating from the iliac veins. Three years later, recurrence was detected, extending from the iliac vessels to the atrium. This required complex thoracoabdominal surgery with an R1/2 resection, indicating a high likelihood of tumor recurrence. Pathologic examination confirmed an angioleiomyomatous tumor. Given its hormone receptor positivity, adjunctive letrozole therapy was initiated. Follow-up scans showed tumor regression, and the patient remains asymptomatic. Discussion: For hormone receptor–positive cases, aromatase inhibitors may offer a viable option for managing recurrent tumors when complete resection is unachievable. Take-Home Message: This case underscores the importance of a multidisciplinary approach for intravenous leiomyomas with cardiac involvement.