Title: “Evolution” of intravascular leiomyomatosis
Version: 1 Date: 17 Jul 2023
Reviewer's report:
General Comments:
This case report titled "Intravenous Leiomyomatosis Following Hysteroscopic Myomectomy:
A Case Report and Implications for Etiology" sheds light on a rare and intriguing phenomenon.
The authors present a detailed case of a 36-year-old woman who developed intravenous
leiomyomatosis (IVL) following a previous hysteroscopic myomectomy. The report provides
valuable insights into the clinical presentation, diagnostic approach, surgical management, and
patient outcomes. Overall, the paper is well-written and presents an interesting observation.
However, to further strengthen the manuscript, I have outlined specific areas that require
attention and revision.
Introduction: The introduction provides a concise overview of IVL and its association with
uterine leiomyomas. However, it would be beneficial to include a more comprehensive literature
review discussing the existing knowledge regarding IVL's etiology, risk factors, and clinical
implications. This would provide a context for the reported case and highlight the significance
of the observation.
Case Presentation: The case presentation provides relevant clinical details and imaging
findings, allowing readers to understand the patient's condition. However, it would be helpful
to provide more information on the patient's medical history, such as the indication for
hysteroscopic myomectomy, any preoperative evaluation, and prior treatments attempted
for uterine leiomyomas. Additionally, including the specific size and characteristics of the
leiomyomas and IVL detected during the procedures would enhance the description of the case.
Surgical Management: While the authors mention that laparoscopic bilateral salpingo-
oophorectomy and hysterectomy were performed, it would be valuable to provide additional
details on the surgical approach, techniques employed, and any intraoperative challenges
encountered. Furthermore, discussing the rationale for selecting this specific treatment strategy
and considering alternative therapeutic options would add depth to the discussion.
Etiological Implications: The authors briefly mention that the cause of IVL is unknown and
propose a potential association with hysteroscopic myomectomy. This observation is intriguing;
however, it is important to acknowledge the limitations of a single case report and the need
for further research to establish causality. Expanding upon the existing theories on IVL's
etiology and discussing the proposed mechanisms linking hysteroscopic myomectomy to IVL
development would strengthen the discussion section.
Conclusion: The conclusion adequately summarizes the case and its implications. However, it
would be valuable to emphasize the need for increased awareness, careful evaluation, and long-
term follow-up of patients undergoing hysteroscopic myomectomy to monitor for the potential
development of IVL. Additionally, suggesting avenues for future research and highlighting the
importance of multi-center studies would be beneficial.
In conclusion, this case report provides valuable insights into the occurrence of IVL following
hysteroscopic myomectomy. With the suggested revisions and additions, the manuscript will
significantly contribute to the literature, prompting further investigation into the etiology, risk
factors, and optimal management of IVL.