Leiomyosarcoma of the renal vein

Primary renal leiomyosarcoma in adult patients: a systematic review and individual patient data analysis

Purpose

The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels.

Method

PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas.

Results

A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size.

Conclusion

Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.

Clinical experience and treatment strategy of leiomyosarcoma originating from the renal vein

Background

Leiomyosarcoma originating from the renal vein (RVLMS) is extremely rare. RVLMS lacks specific clinical manifestations and specific imaging features. This article discusses the epidemiological characteristics and diagnostic difficulties of RVLMS, as well as imaging features, differential diagnosis, treatment strategy, and prognostic factors of this disease.

Method

A case of RVLMS at our center, and 55 cases from the literature based on the PubMed search.

Results

Total operation time was 224 min, and total blood loss during the surgery was 200 ml. Resected tumor was irregular in shape, with negative margins. On the 6th day after the operation, the drainage tube was removed, and the patient was discharged from the hospital. Postoperative pathological results confirmed the renal vein leiomyosarcoma: spindle cell sarcoma, diffuse severe atypia, S-100 (-), SMA ( +), desmin ( +), CD34 (−), CD99 ( +).  Twenty-seven months after the surgery, the patient is alive, and without local recurrence or distant metastases.

Conclusion

Unspecific clinical manifestations and imaging features make the diagnosis of RVLMS difficult. Most patients are diagnosed intra-operatively or following postoperative pathology. Differential diagnosis with paraganglioma (PG) and retroperitoneal sarcoma (RPS) should be made. Early and complete resection is considered as the first choice of treatment, and whether to preserve the kidney is based on the patient's condition. RVLMS is highly malignant, and may recur locally or metastasize to distant locations; therefore, adjuvant therapy and regular follow-up should be carried out after surgery.

Leiomyosarcoma of renal vein: A case report

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We present a case of renal vein leiomyosarcoma in a patient presented with left flank pain. The patient underwent radical nephrectomy with tumour excision.

Leiomyosarcoma of the renal vein: analysis of outcome and prognostic factors in the world case series of 67 patients

BACKGROUND

Leiomyosarcoma is a rare malignant mesenchymal tumour. Some cases of leiomyosarcoma of the renal vein (LRV) have been reported in the literature, but no analysis of data and search for prognostic factors have been done so far. The aim of this review was to describe the LRV, to analyse overall survival (OS), local recurrence free survival (LRFS) and distant metastases free survival (DMFS) in LRV world case series and to identify significant predictors of OS, LRFS and DMFS.

METHODS

Cases from the literature based on PubMed search and a case from our institution were included.

RESULTS

Sixty-seven patients with a mean age of 56.6 years were identified; 76.1% were women. Mean tumour size was 8.9 cm; in 68.7% located on the left side. Tumour thrombus extended into the inferior vena cava lumen in 13.4%. All patients but one underwent surgery (98.5%). After a median follow up of 24 months, the OS was 79.5%. LRFS was 83.5% after a median follow up of 21.5 months and DMFS was 76.1% after a median follow up of 22 months. Factors predictive of OS in univariate analysis were surgical margins, while factors predictive of LRFS were inferior vena cava luminal extension and grade. No factors predictive of DMFS were identified. In multivariate analysis none of the factors were predictive of OS, LRFS and DMFS.

CONCLUSIONS

Based on the literature review and presented case some conclusions can be made. LRV is usually located in the hilum of the kidney. It should be considered in differential diagnosis of renal and retroperitoneal masses, particularly in women over the age 40, on the left side and in the absence of haematuria. Core needle biopsy should be performed. Patients should be managed by sarcoma multidisciplinary team. LRV should be surgically removed, with negative margins.

Robot-assisted Laparoscopic Resection of Renal Vein Leiomyosarcoma

Leiomyosarcoma, a rare and aggressive retroperitoneal tumor, arises from the smooth muscle of the tunica media. Accurate preoperative diagnosis is rare as the origin is often unclear, and its involvement of the vessels makes biopsy prohibitively dangerous (Maturen et al, 2013⁶). Herein, we describe the laparoscopic dissection of a retroperitoneal renal vein tumor using a robotic approach.

An uncommonly encountered perirenal mass: Robotic resection of renal vein leiomyosarcoma

Primary leiomyosarcoma (LMS) of the renal vein is a rare tumour and poorly described in the literature. Surgical resection, using open and laparoscopic approaches, is the mainstay of treatment. In this report, we describe a patient with left renal vein LMS, report the first robotic laparoscopic resection for this tumor, and review the typical presentation, imaging, pathology and treatment for this rare clinical entity.

Primary renal vein leiomyosarcoma: a case report

Primary renal vein leiomyosarcoma (LMS) is a rare tumor with only a few cases reported in the literature. Clinical diagnosis of renal vein LMS can be difficult because of nonspecific symptoms and nonpathognomonic radiological features. The primary treatment modality is radical nephrectomy followed by chemotherapy and/or radiotherapy. There is scarcity of literature regarding prognosis because of rarity of tumor; however, tumor size (>3 cm) determines the risk of local recurrence and distant metastasis. Overall prognosis of renal vein LMS is poor. Here, we describe clinical and histopathological features of a 50-year-old female patient with LMS of right renal vein.

Non-vena cava venous leiomyosarcomas: a review of the literature

BACKGROUND

Leiomyosarcoma (LMS) is a rare malignant tumor of smooth muscle origin that generally stems from soft tissues and uterine tissue. However, a small percentage of this sarcoma subset may originate from the smooth muscle of vessel walls, most of which are of venous origin. Although the vena cava (VC) serves as the most likely source for these tumors and has been well described in the literature, there is limited information focused on non-VC LMS derived from large veins. The focus of this study was to consolidate the reports and previously published data of all non-VC LMS of venous origin to better characterize and describe this disease process.

METHODS

We reviewed information derived from 143 previously published cases.

RESULTS AND CONCLUSIONS

It was determined that women aged 60-69 years were most commonly diagnosed with this particular type of tumor, with the most common tumor site being the renal vein. Metastasis was present in 12% of this population at the time of diagnosis, and 32% of patients were alive 4 years later.

Leiomyosarcoma of the renal vein

A 43-year-old woman was referred to our clinic for evaluation of a left retroperitoneal mass. She presented to our internal medicine department complaining of back pain. Computed tomography (CT) scan revealed a left retroperitoneal mass 55 mm in size in the hilum of the left kidney. Enhanced CT scan and magnetic resonance imaging (MRI) disclosed a poorly staining mass. Metaiodobenzylguanidine scintigraphy demonstrated no accumulation in the mass; moreover, endocrinologic examination was normal. Laparoscopic resection of the left retroperitoneal tumor was attempted; however, strong adhesion between the tumor and the left renal vein was encountered. Thus, left nephrectomy after open conversion was performed. Histological findings indicated leiomyosarcoma originating from the left renal vein. The postoperative course has been uneventful; neither recurrence nor metastasis is evident 2 years postsurgery.

Leiomyosarcoma of the renal vein: arterial encasement on contrast-enhanced dynamic computed tomography

We report a case of leiomyosarcoma of the renal vein, which is a rare tumor with no more than 30 cases found in the published English language literature. This case demonstrates encasement of the renal artery by the tumor mass, a previously unreported manifestation. The present study could be useful in considering this rare tumor in the differential diagnosis of renal hilar tumors.

Leiomyosarcoma of the renal vein: case report and review of the literature

Leiomyosarcomas of vascular origin is a rare and aggressive pathology, its presentation on the renal vein is infrequent, of which 29 cases have been reported world-wide. We describe a case of a 76 year-old woman, who presented with intermittent left flank pain, irradiated to the lumbar region of 6 months duration. A left radical nephrectomy with en-bloc resection of a para-aortic tumor was performed. Microscopic examination of the specimen reported a moderately differentiated leiomyosarcoma, originated in the wall of the renal vein. The patient received adjuvant chemotherapy and radiation therapy. The tumor recurred in the liver. After 24 months from the primary surgery, the patient is alive with evidence of multiple metastatic spread to the liver. She is now under palliative care.

Leiomyosarcoma of the renal vein

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.