Uterine Intravenous Leiomyomatosis with Internal Iliac Artery Involvement.

Background: Intravenous leiomyomatosis (IVL) is a rare benign uterine smooth muscle tumor that typically spreads along venous channels. Arterial extension is exceedingly uncommon but presents greater surgical challenges and may adversely affect prognosis. Case Report: We describe a case of IVL extending into the internal iliac artery in a 32-year-old woman. The diagnosis was established through comprehensive imaging, including ultrasound and magnetic resonance imaging (MRI), and confirmed by histopathology. Given the vascular involvement, the lesion was excised laparoscopically. Conclusion: In atypical cases of IVL with arterial involvement, surgical complexity is substantially greater than in venous disease, as arterial invasion complicates vascular dissection and hinders complete clearance. This increases the risk of recurrence and may negatively influence long-term prognosis. In the present case, laparoscopic resection allowed precise vascular control, minimized surgical trauma, and facilitated recovery. Early diagnosis, radical excision, and continued surveillance remain essential for optimizing outcomes.