• Yang Tan, Jing Han, Zhenglan Wang, Ju Yan, Lin Dong, and Rui Liu.
• Department of Pathology, Dujiangyan Maternity and Child Health Hospital, Chengdu, Sichuan, China.
• Medicine (Baltimore). 2024 Jan 12; 103 (2): e36887e36887.

RationaleIntravascular/intravenous leiomyomatosis (IVL) is a peculiar variant of uterine leiomyoma that is classified as a histologically benign smooth muscle tumor with a biological behavior similar to that of a malignant tumor. It is characterized by the proliferation of leiomyomas spreading along the uterine and extrauterine venous circulation.Patient ConcernsHerein, we present 2 cases of IVL who had completely different clinical manifestations to stress the need for constant vigilance of IVL diagnosis and the understanding of uterine leiomyoma heterogenicity. Case 1 was registered for fever without specific triggering factors, irregular menstruation and clinically diagnosed uterine diverticula, while no information about fibroids was mentioned. Case 2 was characterized by an aggressively growing abdominal mass. With a large space-occupying lesion in the right abdominopelvic cavity and no imaging evidence of involvement of the iliac vein or above vein, the patient was initially diagnosed with multiple myomata.DiagnosesBoth patients' diagnoses were confirmed as IVL by histopathology. To our knowledge, the mass of case 1 is the minimum IVL in the English literature.InterventionsSubtotal hysterectomy with bilateral salpingectomy was performed on the former, while total hysterectomy with bilateral salpingectomy was performed on the latter.OutcomesBoth patients were comfortable, and no relapse occurred.LessonsTwo cases in the study showed 2 different proceeding stages of the same disease and corroborated multiple pathogeneses, which have been mentioned in the available literature on IVL. Our work provides both supplement for clinical data to facilitate further research and better understanding of special types of fibroids to clinicians.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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