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D'Amone G, Cirimele V, Rossi SM, Ciolli A, Bitonti MT, Stiffi M, Ricci M, Baldazzi D, Ferrari U, Zobel BB, Faiella E. Chronic graft thrombosis after en bloc resection of inferior vena cava leiomyosarcoma. A case report. Radiol Case Rep 2024; 19:468-472. [PMID: 38046913 PMCID: PMC10692464 DOI: 10.1016/j.radcr.2023.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 12/05/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare malignant tumor originating from smooth muscle cells. Primary leiomyosarcomas arising from vessels' walls are extremely rare (2%), with LMS of inferior vena cava being the most frequent subtype. We present the case of a 45-year-old man with a past medical history of resected leiomyosarcoma of the right calf, presenting with a follow-up CT showing a retroperitoneal mass arising from the inferior vena cava, which proved to be IVC leiomyosarcoma at histopathology. The patient underwent surgical resection of the mass with prosthetic reconstruction of the IVC. Three days after surgery he developed complete thrombosis of IVC graft which persisted at 3-months follow-up imaging and was treated with pharmacological therapy. Although there are many references reporting the association between LMS of the inferior vena cava and postoperative deep vein thrombosis, to our knowledge there are no reports currently available regarding complete thrombosis of IVC vascular graft after surgical resection of IVC LMS.
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Affiliation(s)
- Giulia D'Amone
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Vincenzo Cirimele
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Silvia Maria Rossi
- Department of Human Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Alessandro Ciolli
- Division of Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Maria Teresa Bitonti
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Massimo Stiffi
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Milena Ricci
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Dalila Baldazzi
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Ugo Ferrari
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Eliodoro Faiella
- Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Chellasamy RT, Sivanesan A, Kalyanasundaram A, Munusamy H, Rajarajan N. Approach to Different Types of Inferior Vena Cava Leiomyosarcomas: A Vascular Surgeon's Perspective. Cureus 2023; 15:e40694. [PMID: 37485149 PMCID: PMC10358784 DOI: 10.7759/cureus.40694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare smooth muscle tumor, and only a few cases have been reported with involvement of the inferior vena cava (IVC). Inferior vena cava LMS is more often silent and usually has a poor prognosis as the patients present late. We present this case series to showcase the different approaches to surgical resection, as each tumor had a different location in the IVC. We emphasize preoperative surgical planning to achieve a tumor-free margin and maintain hemodynamics at the same time.
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Affiliation(s)
- Rajeev Thilak Chellasamy
- Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ananthkumar Sivanesan
- Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Aravind Kalyanasundaram
- Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Hemachandren Munusamy
- Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Nembian Rajarajan
- Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Ebinesh A, Ashta A, Satyam, Pradhan GS, Sharma R, Das P. Incidentally Diagnosed Extraluminal Leiomyosarcoma of Infrarenal Inferior Vena Cava: A Case Report and Literature Review from a Radiologist's Perspective. Acta Med Litu 2022; 29:258-270. [PMID: 37733410 PMCID: PMC9799014 DOI: 10.15388/amed.2022.29.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023] Open
Abstract
Background Vascular leiomyosarcoma is a rare but most common vascular tumor of the inferior vena cava. Case presentation We present the case of an incidentally diagnosed extraluminal leiomyosarcoma of the inferior vena cava in a 62 year old patient who presented with abdominal pain following blunt trauma. Ultrasonography showed a lobulated hypoechoic lesion in the upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a circumscribed lobulated near homogeneously enhancing retroperitoneal lesion in anterior relation to the infrarenal inferior vena cava, right paramedian in location with imperceptible vena caval lumen at the site of maximum contact. In positron emission tomography (PET) CT the lesion showed mild fluorodeoxyglucose (FDG) uptake with no distant metastases. CT guided biopsy with immunohistochemical analysis showed leiomyosarcoma. Patient underwent surgical resection with inferior vena cava reconstruction. Conclusions Leiomyosarcoma of the inferior vena cava is a rare tumor of vascular origin. Imaging plays an imperative role in the diagnosis and preoperative evaluation. This article also provides a comprehensive literature review of the radiological features of inferior vena caval leiomyosarcoma that would aid in optimal preoperative characterization and evaluation.
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Affiliation(s)
- A Ebinesh
- Department of Radiodiagnosis, Maulana Azad Medical College and associated hospitals, Jawahar Lal Nehru Marg, New Delhi, India
| | - Aanchal Ashta
- Department of Radiology, Maulana Azad Medical College and associated hospitals, Jawahar Lal Nehru Marg, New Delhi, India
| | - Satyam
- Department of Radiodiagnosis, Maulana Azad Medical College and associated hospitals, Jawahar Lal Nehru Marg, New Delhi, India
| | - Gaurav Shanker Pradhan
- Department of Radiodiagnosis, Maulana Azad Medical College and associated hospitals, Jawahar Lal Nehru Marg, New Delhi, India
| | - Rohin Sharma
- Department of Radiodiagnosis, Maulana Azad Medical College and associated hospitals, Jawahar Lal Nehru Marg, New Delhi, India
| | - Prince Das
- Department of Radiology, Maulana Azad Medical College and associated hospitals, Jawahar Lal Nehru Marg, New Delhi-110002, India
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Malki Y, Lazaar H, Bouhout T, Serji B, Benzirar A, El Harroudi T. Infrarenal Vena Cava Leiomyosarcoma Treated With Surgical Resection and Vascular Reconstruction. Cureus 2021; 13:e15808. [PMID: 34306875 PMCID: PMC8294025 DOI: 10.7759/cureus.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava is a rare malignant tumor with a poor prognosis. We report a case of a 39-year-old woman admitted for a surgical resection of a retroperitoneal mass revealed by pain localised in the right lumbar fossa. Computed tomography of the abdomen revealed a heterogeneous retroperitoneal mass compressing the inferior vena cava. Surgical resection was performed with the reconstruction of the inferior vena cava using a Dacron prosthesis, the diagnosis of vessel wall leiomyosarcoma was revealed by histopathology. Surgical resection with clear margins remains the only treatment offering the best survival rate. The complex nature of the surgery of those tumors is a major therapeutic challenge for surgeons.
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Affiliation(s)
- Yosra Malki
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Hatim Lazaar
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tariq Bouhout
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Adnan Benzirar
- Vascular Surgery, Medical School University Oujda, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
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Oliveira R, Pires V, Macedo C, Madeira J. Unexpected inferior vena cava syndrome: leiomyosarcoma. BMJ Case Rep 2021; 14:14/3/e239839. [PMID: 33782067 PMCID: PMC8009215 DOI: 10.1136/bcr-2020-239839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leiomyosarcomas arising directly from the blood vessels are rare. These tumours are formed from the muscular wall of either a major vein or artery. The authors describe the case of an 84-year-old woman with lower back pain with bilateral abdominal irradiation and marked peripheral oedema, who was diagnosed with leiomyosarcoma of the inferior vena cava after biopsy of an infrahepatic mass. An endovascular prosthesis was placed as the patient was proposed for palliative care. Leiomyosarcomas of the inferior vena cava may present with non-specific symptoms. Therefore, the authors aim to draw attention to the diagnosis process, as well as imaging findings related to this pathology.
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Affiliation(s)
- Raquel Oliveira
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Verena Pires
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cristiane Macedo
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Joana Madeira
- Department of Pathology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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Graves A, Longoria J, Graves G, Ianiro C. Leiomyosarcoma of the inferior vena cava: a case report. J Surg Case Rep 2020; 2020:rjaa479. [PMID: 33274043 PMCID: PMC7694595 DOI: 10.1093/jscr/rjaa479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022] Open
Abstract
Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is an extremely rare malignancy with <400 cases reported. We present a 42-year-old woman with a 3-day history of vague and non-specific abdominal pain. Examination revealed mild tenderness to the epigastrium and right upper quadrant with no other findings. Abdominal ultrasound was performed, which revealed a large hypoechoic mass overlying the IVC. Abdominal computed tomography (CT) was performed which revealed an 8.9 × 7.9 × 9 cm multilobulated lesion encasing the IVC. A CT-guided biopsy was performed which revealed a primary LMS of the IVC. Surgical en bloc excision was performed with an end-to-end Dacron graft for IVC reconstruction. Histopathology confirmed LMS of the vessel wall with negative surgical margins.
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Affiliation(s)
| | - James Longoria
- Sutter Medical Center Sacramento, Capitol Surgical Associates, Sacramento, CA, USA
| | - Gregory Graves
- Sutter Medical Center Sacramento, Capitol Surgical Associates, Sacramento, CA, USA
| | - Cora Ianiro
- Sutter Medical Center Sacramento, Capitol Surgical Associates, Sacramento, CA, USA
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Dyspnea due to an uncommon vascular tumor: leiomyosarcoma of the infrahepatic vena cava inferior. Surg Case Rep 2020; 6:136. [PMID: 32548741 PMCID: PMC7297879 DOI: 10.1186/s40792-020-00896-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignancy that originated from the smooth muscle tissue of the vascular wall. Diagnoses, as well as, treatment of the disease are still challenging and to date, a radical surgical resection of the tumor is the only curative approach. Case report We report on the case of a 49-year old male patient who presented with suddenly experienced dyspnea. Besides bilateral pulmonary arterial embolism, a lesion close to the head of the pancreas was found using CT scan, infiltrating the infrahepatic IVC. Percutaneous ultrasound-guided biopsy revealed a low-grade LMS. Intraoperatively, a tumor of the IVC was observed without infiltration of surrounding organs or distant metastases. Consequently, the tumor was removed successfully, by en-bloc resection including prosthetic graft placement of the IVC. Histological workup revealed a completely resected (R0) moderately differentiated LMS of the IVC. Conclusion LMS of the infrahepatic IVC is an uncommon tumor, which may present with dyspnea as its first clinical sign. Patients benefit from radical tumor resection. However, due to the poor prognosis of vascular LMS, a careful follow-up is mandatory.
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