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Baheen Q, Bi H, Wang K, Lu M, Zhang H, Ma L. Clinical experience and treatment strategy of leiomyosarcoma originating from the renal vein. Eur J Med Res 2022; 27:100. [PMID: 35761392 PMCID: PMC9235132 DOI: 10.1186/s40001-022-00721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Qais Baheen
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Hai Bi
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | | | - Min Lu
- Department of Pathology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China.
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Novak M, Perhavec A, Maturen KE, Pavlovic Djokic S, Jereb S, Erzen D. Leiomyosarcoma of the renal vein: analysis of outcome and prognostic factors in the world case series of 67 patients. Radiol Oncol 2017; 51:56-64. [PMID: 28265233 PMCID: PMC5330168 DOI: 10.1515/raon-2016-0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/05/2016] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Marko Novak
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Katherine E. Maturen
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | | | - Simona Jereb
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Darja Erzen
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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3
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Devlin CM, Gill K, Thomas J, Biyani CS. Renal vein leiomyosarcoma and renal cell carcinoma presenting together: A case report and discussion on the follow-up. Can Urol Assoc J 2015; 9:E517-20. [PMID: 26279729 PMCID: PMC4514505 DOI: 10.5489/cuaj.2846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Leiomyosarcoma affecting the renal vein is rare, with about 30 documented cases in the English literature. The appearance on computed tomography can be difficult to interpret and is often confused with advanced renal cell carcinoma (RCC). This confusion can have implications on the perioperative care of patients presenting with this disease. We report a case with an usual radiological appearance of a renal vein leiomyosarcoma, alongside a separate RCC. This case highlights the need for a high index of suspicion in radiological reporting and provides a dilemma in regards to postoperative surveillance.
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Affiliation(s)
- Conor M. Devlin
- St. James’s University Hospital, Beckett Street, Leeds, UK; Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire, UK
| | - Kanwar Gill
- St. James’s University Hospital, Beckett Street, Leeds, UK; Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire, UK
| | - Jennifer Thomas
- St. James’s University Hospital, Beckett Street, Leeds, UK; Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire, UK
| | - Chandra Shekhar Biyani
- St. James’s University Hospital, Beckett Street, Leeds, UK; Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire, UK
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4
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Doyle Z, Wolford B, Morshedi MM, Santillan CS. Intravascular lipoma of the renal vein. BJR Case Rep 2015; 1:20150072. [PMID: 30363167 PMCID: PMC6159127 DOI: 10.1259/bjrcr.20150072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/14/2015] [Accepted: 04/26/2015] [Indexed: 11/15/2022] Open
Abstract
Lipomas are benign neoplasms composed of adipocytes encased in a fibrous capsule. Intravascular lipomas are rare and almost always incidental findings. In the published literature, the majority are described within the inferior vena cava (IVC) and less frequently reported in the superior vena cava, brachiocephalic vein, subclavian vein, internal jugular vein, external iliac vein and common femoral vein. We present the case of a 59-year-old male who presented with a symptomatic ureteral calculus and was found to have an intravascular lipoma of the right renal vein with extension into the IVC. To our knowledge, this is the first ever report of an intravascular lipoma in the renal vein. We discuss the imaging characteristics of intravascular lipomas and the differential diagnosis that should be considered.
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5
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Renal vein leiomyosarcoma: imaging and clinical features of a renal cell carcinoma mimic. ACTA ACUST UNITED AC 2013; 38:379-87. [PMID: 22476373 DOI: 10.1007/s00261-012-9888-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Renal vein leiomyosarcoma is a rare tumor whose clinical and imaging features can significantly overlap with those of advanced primary renal neoplasms, particularly renal cell carcinoma. IRB approval was obtained for a retrospective review of clinical and imaging information for five patients with the pathologically proven diagnosis of renal vein leiomyosarcoma at two institutions. Among the five patients, two were female and three male; average age 58.6 (range 42-77). Three patients presented with flank or abdominal pain, one with pulmonary embolism, and one with weight loss and fatigue. Mass size ranged from 4 to 10 cm. Four masses were left-sided and one right-sided. Tumors involved and expanded the renal vein in all cases, with tumor extension to the renal hilum in one case, through the renal hilum into renal parenchyma in two cases, and into inferior vena cava in two cases. All masses demonstrated contrast enhancement, which was solely peripheral in one case. In all cases, extrarenal tumor volume was greater than renal parenchymal tumor volume. When renal masses are predominantly or exclusively intravascular, consideration should be given to the diagnosis of renal vein leiomyosarcoma because preoperative biopsy results could significantly alter management.
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6
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Gage MJ, Patel AV, Koenig KL, Newman E. Non-vena cava venous leiomyosarcomas: a review of the literature. Ann Surg Oncol 2012; 19:3368-74. [PMID: 22618717 DOI: 10.1245/s10434-012-2379-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Mark J Gage
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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7
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Fahrig C, Heidrich H. Leiomyosarcoma of the common femoral and external iliac veins. Int J Angiol 2011. [DOI: 10.1007/bf01616827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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8
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Imao T, Amano T, Takemae K. Leiomyosarcoma of the renal vein. Int J Clin Oncol 2010; 16:76-9. [PMID: 20694494 DOI: 10.1007/s10147-010-0115-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 07/06/2010] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Tetsuya Imao
- Department of Urology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, Nagano 380-8582, Japan.
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Maeda T, Tateishi U, Fujimoto H, Kanai Y, Sugimura K, Arai Y. Leiomyosarcoma of the renal vein: arterial encasement on contrast-enhanced dynamic computed tomography. Int J Urol 2006; 13:611-2. [PMID: 16771735 DOI: 10.1111/j.1442-2042.2006.01364.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Tetsuo Maeda
- Diagnostic Radiology Division, National Cancer Center Hospital, Tokyo, and Department of Radiology, Kobe University Graduate School of Medicine, Japan
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Aguilar IC, Benavente VA, Pow-Sang MR, Morante CM, Meza L, Destefano V, Ruiz E, Garcia J. Leiomyosarcoma of the renal vein: case report and review of the literature. Urol Oncol 2005; 23:22-6. [PMID: 15885579 DOI: 10.1016/j.urolonc.2004.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 05/26/2004] [Accepted: 06/01/2004] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Ivan C Aguilar
- Department of Urology, Instituto Especializado de Enfermedades Neoplasicas Dr. Eduardo Caceres Graziani, Lima, Perú
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11
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Kaushik S, Neifeld JP. Leiomyosarcoma of the renal vein: imaging and surgical reconstruction. AJR Am J Roentgenol 2002; 179:276-7. [PMID: 12076953 DOI: 10.2214/ajr.179.1.1790276] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shaifali Kaushik
- Medical College of Virginia Hospital, Richmond, VA 23298-0615, USA
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12
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Abstract
The preoperative diagnosis for primary leiomyosarcoma of the renal vein, an extremely rare tumor, is difficult. The tumor predominantly occurs in women and on the left side. Its natural history is toward distant metastases and a poor 5-year survival rate. Nephrectomy and en-bloc surgical resection remain the mainstay of therapy. We present three such cases and review the world literature.
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Affiliation(s)
- S B Brandes
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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