Primary leiomyosarcoma of the great saphenous vein: A case report

Decoding Femoral Vein Leiomyosarcoma: A Rare Vascular Malignancy Revealed Through Imaging

Lumps are commonly found in the femoral triangle. Femoral hernias and lymphadenopathy are included in the differential diagnosis. One of the rare possibilities of femoral triangle swellings is leiomyosarcoma. Leiomyosarcoma originating from the walls of blood vessels is very rare, and only a few cases are reported. We present a case of a 50-year-old male patient complaining of swelling over the left thigh. Ultrasonography showed a highly vascular soft tissue tumour in the anteromedial compartment of the thigh. Magnetic resonance imaging (MRI) was done later. It showed a well-defined, heterogeneously enhancing solid cystic lesion along the femoral vein with intravenous extension, and the femoral artery was seen encasing along its length. A surgical exploration of the lesion suggested a mass originating from the femoral vein, obstructing the vein itself. The mass was excised, and the defect in the vein was repaired. Histopathological examination revealed the mass to be leiomyosarcoma of vascular origin.

MRI of Soft-Tissue Tumors: What to Include in the Report

MRI serves as a critical step in the workup, local staging, and treatment planning of extremity soft-tissue masses. For the radiologist to meaningfully contribute to the management of soft-tissue masses, they need to provide a detailed list of descriptors of the lesion outlined in an organized report. While it is occasionally possible to use MRI to provide a diagnosis for patients with a mass, it is more often used to help with determining the differential diagnosis and planning of biopsies, surgery, radiation treatment, and chemotherapy (when provided). Each descriptor on the list outlined in this article is specifically aimed to assist in one or more facets of the overall approach to soft-tissue masses. This applies to all masses, but in particular sarcomas. Those descriptors are useful to help narrow the differential diagnosis and ensure concordance with a pathologic diagnosis and its accompanying grade assignment of soft-tissue sarcomas. These include a lesion's borders and shape, signal characteristics, and contrast enhancement pattern; the presence of peritumoral edema and peritumoral enhancement; and the presence of lymph nodes. The items most helpful in assisting surgical planning include a lesion's anatomic location, site of origin, size, location relative to a landmark, relationship to adjacent structures, and vascularity including feeding and draining vessels. The authors provide some background information on soft-tissue sarcomas, including their diagnosis and treatment, for the general radiologist and as a refresher for radiologists who are more experienced in tumor imaging. ©RSNA, 2024 See the invited commentary by Murphey in this issue.

Great saphenous vein leiomyosarcoma mimicking thrombosed aneurysm: A case report and review of the literature

Vascular leiomyosarcoma LMS. is an extremely rare subgroup of LMSs. Fewer than 50 cases of LMS originating from the great saphenous vein have been reported. In 43% of reported cases, LMS was misdiagnosed clinically. In our case, the patient was initially misdiagnosed as having a thrombosed aneurysm. This misdiagnosis could be due to the rarity of great saphenous vein LMS cases, for which a high index of suspicion is needed, and because no specific radiologic findings have been established for diagnosing LMSs. Masses presenting along the course of vessels should be suspected for malignancy, which can be helpful in performing definitive surgery and avoiding multiple surgeries.