Intravenous leiomyomatosis successfully treated by multidisciplinary treatment including GnRH antagonist Relugolix

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction:</jats:title> <jats:p>Intravenous leiomyomatosis (IVLM) occurs when a leiomyoma arises from uterine smooth muscle cells and extends into the veins. It is rare and is often difficult to treat. We report a case of leiomyoma that extended into the ovarian and internal iliac veins and pelvic cavity, which was successfully resected after multidisciplinary treatment.</jats:p> </jats:sec> <jats:sec> <jats:title>Patient concerns:</jats:title> <jats:p>A 49-year-old, premenopausal Chinese woman was referred to our department after a follow-up for uterine myoma revealed a sudden increase in size of the pelvic tumor with intravascular growth.</jats:p> </jats:sec> <jats:sec> <jats:title>Diagnosis and Interventions:</jats:title> <jats:p>We suspected IVLM and administered relugolix (gonadotropin-releasing hormone antagonist) for 5 months. The tumor shrank by 76%. We selectively embolized the internal iliac and uterine arteries and performed a laparotomy, completely resecting the tumor. Relugolix was administered for 5 months postoperatively, then switched to the aromatase inhibitor letrozole.</jats:p> </jats:sec> <jats:sec> <jats:title>Outcomes:</jats:title> <jats:p>At 14 months postoperatively, there was no evidence of recurrence.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>This is the first report demonstrating the efficacy of a gonadotropin-releasing hormone antagonist for IVLM. Preoperative relugolix therapy followed by radical surgery is a promising strategy for patients with IVLM.</jats:p> </jats:sec>