Intravascular leiomyoma
Clinical presentations	Diagnostic tools	Differential diagnosis	Treatment modalities	Follow-up
Symptoms(depending on sites, and sizes) Dyspnea (most common) Abdominal/pelvic pain Thrombosis-related symptoms Signs (depending on sites, and sizes) Pelvic mass Vaginal bleeding Abdominal distension Asymptomatic < 1/3 of cases	Doppler US and/or TVUS To initially detect intravascular lesions, to assess any abnormality of blood flow, but low accuracy in mass characterization Echocardiography Useful in case of cardiac involvement CT angiography To map vascular involvement MRI with contrast To better characterize the soft tissues of lesions PET-CT/MRI If malignancy is suspected Histopathology To obtain definitive diagnosis	Leiomyosarcoma Intravenous thrombus PEComa Metastatic disease	Multidisciplinary discussion To determine the best therapeutical approach, the potential surgical radicality, and patient’s operability Surgical resection Preferred treatment to achieve complete surgical removal Surgical access Depending on position, and size of lesion Morcellation It should be avoided, containment bags should be used CPB Useful in case of lesions strictly adherent to cardiac structures Hormonal treatment It should be avoided as primary treatment due to high risk of cardiovascular events; useful as maintenance therapy after surgery	Not-well defined Echocardiography and/or Doppler US To evaluate regression, progression, or recurrence Re-excision It may be considered in case of residual lesions, or recurrences
US: ultrasound; TVUS: trans-vaginal ultrasound; CT: computed tomography; MRI: magnetic resonance imaging; PET: positron emission tomography; PEComa: perivascular epithelioid cell tumor; CBP: cardiopulmonary by-pass.