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Kushwaha NK, Jaiswal P, Singh VP, Dhaman PK. Resecting Lower Segment Inferior Vena Cava Leiomyosarcoma With Middle Segment Extension While Avoiding Renal Morbidity. Vasc Endovascular Surg 2024:15385744241276607. [PMID: 39155150 DOI: 10.1177/15385744241276607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and aggressive mesenchymal tumor, with less than 400 reported cases to date. Complete resection of the tumor with clear margins is the only proven curative treatment, providing survival benefits. Nonetheless, leiomyosarcomas in the middle segment or those extending up to it within the inferior vena cava (IVC) frequently necessitate renal reimplantation or nephrectomy, with rates varying between 56% and 75%. In this case report, we present a 65-year-old female with lower segment IVC leiomyosarcoma with middle segment extension, successfully resected and reconstructed while avoiding associated renal reimplantation or nephrectomy morbidity.
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Affiliation(s)
| | - Pradeep Jaiswal
- Surgical Oncology, Army Hospital (Research & Referral), New Delhi, India
| | - Vijay Pratap Singh
- Surgical Oncology, Army Hospital (Research & Referral), New Delhi, India
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Maniso FH, Woldegeorgis MA, Bedada HF. Surgical and oncologic approach to leiomyosarcoma of the inferior vena cava: A case report. Clin Case Rep 2024; 12:e9336. [PMID: 39171334 PMCID: PMC11335577 DOI: 10.1002/ccr3.9336] [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] [Received: 06/12/2024] [Revised: 06/29/2024] [Accepted: 07/21/2024] [Indexed: 08/23/2024] Open
Abstract
Key Clinical Message LMS of IVC needs a multidisciplinary approach. Surgical excision with free margin is the cornerstone of management. Upon case-by-case selection, adjuvant chemotherapy may play a role in better oncologic outcome. Abstract Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare form of mesenchymal origin malignancy with less than 400 cases reported to date. Surgery is the mainstay of management but it requires vast experience in vascular and visceral surgery to attain a free tumor margin. Subsequent adjuvant treatment with chemotherapy and radiation remains as an area of gray zone. We report the case of a 61-year-old man with an 8-month history of abdominal pain. Upon physical examination, an ill-defined mass over the right side of the lower abdomen and bilateral lower extremity edema were detected. Abdominal ultrasound with Doppler revealed a right-side retroperitoneal mass invading the IVC with extensive venous thrombosis for which anticoagulation was initiated. Computed Tomography of the abdomen revealed a huge heterogeneously enhancing mass involving the whole length of the infrarenal IVC obstructing the IVC lumen with collateral veins draining through the paralumbar veins and inferior epigastric veins bilaterally. With a top differential of primary IVC LMS, a midline longitudinal laparotomy was performed with an intraoperative finding of a tumor arising from the infra-renal IVC which was excised. Gore-Tex graft was used to reconstruct the IVC. There was an injury to the right common iliac artery and it was repaired by end-to-end anastomosis. Histopathology confirmed a high-grade LMS of the IVC and surgical margin status was unknown. He was given adjuvant Chemotherapy consisting of Doxorubicin and Dacarbazine. He has been on follow-up at the Oncology side with a good performance status.
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Affiliation(s)
- Feleke Hailmariam Maniso
- Department of Clinical OncologyTikur Anbessa Specialized Hospital, College of Health Science, Addis Ababa UniversityAddis AbabaEthiopia
- Oncology Unit, St. Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | - Mathewos Assefa Woldegeorgis
- Department of Clinical OncologyTikur Anbessa Specialized Hospital, College of Health Science, Addis Ababa UniversityAddis AbabaEthiopia
| | - Hawi Furgassa Bedada
- Department of Clinical OncologyTikur Anbessa Specialized Hospital, College of Health Science, Addis Ababa UniversityAddis AbabaEthiopia
- Oncology Unit, St. Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
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Bertrand T, Faron M, Mercier O, Ngo C, Le Pechoux C, Levy A, Issard J, Henon C, Honoré C, Fadel E, Le Cesne A. Vena cava leiomyosarcoma surgery results in a retrospective cohort of 41 patients from two centers. J Surg Oncol 2024. [PMID: 38973131 DOI: 10.1002/jso.27765] [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: 03/29/2024] [Accepted: 06/14/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Leiomyosarcoma of the vena cava (LMS-VC) is a rare entity with poor oncological outcomes and a lack of histological staging prognostic factors. METHODS Outcomes of consecutive patients operated on LMS-VC between March 2003 and May 2022, in two specialized sarcoma centers were reported. RESULT Forty-one patients were identified. Median size of LMS-VC was 9 cm with 68% of complete obstruction. After surgery, severe complication rate was 30%. No postoperative mortality was reported. Microscopic complete excision was obtained for 71% of patients, R1 for 27% and one patient presented an R2 resection. Grade 3 was found in 24%. After a median follow-up of 70 months, 3 years disease-free survival (DFS) and 5 years DFS were 34% and 17%, and 3 years overall survival (OS) and 5 years OS were 74% and 50%. Distant metastasis concerned 54% of recurrences, local 7% and local and distant 5%. Multivariate analysis showed that FNCLCC grade (p < 0.001) and perioperative chemotherapy (p = 0.026) were significant factors for DFS. In multivariate analysis, FNCLCC grade was a significant factor for OS (p = 0.004). DISCUSSION Perioperative chemotherapy may have a role to play in lowering the risk of recurrence for LMS-VC, particularly in high-grade tumor.
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Affiliation(s)
- Thibaud Bertrand
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- INSERM 1018, CESP, Equipe ONCOSTAT, Université Paris Saclay, Villejuif, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-Lung Transplantation Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Carine Ngo
- Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cécile Le Pechoux
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antonin Levy
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
- INSERM 1030, Molecular Radiotherapy and Therapeutic innovations, Université Paris Saclay, Villejuif, France
| | - Justin Issard
- Department of Thoracic Surgery and Heart-Lung Transplantation Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Clémence Henon
- INSERM 1030, Molecular Radiotherapy and Therapeutic innovations, Université Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-Lung Transplantation Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Axel Le Cesne
- INSERM 1030, Molecular Radiotherapy and Therapeutic innovations, Université Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
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Shafique HS, Commander SJ, Blazer DG, Kim Y, Southerland KW, Williams ZF. Surgical outcomes of patients with inferior vena cava leiomyosarcoma. J Vasc Surg Venous Lymphat Disord 2024; 12:101885. [PMID: 38552955 DOI: 10.1016/j.jvsv.2024.101885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Primary vascular leiomyosarcomas are incredibly rare and have a poor prognosis. The purpose of this study was to analyze the surgical outcomes of patients with primary inferior vena cava (IVC) leiomyosarcoma. METHODS We performed a retrospective review of IVC leiomyosarcoma resections performed at a single tertiary care hospital from 2014 to 2023. A total of 13 cases were analyzed, including 10 women and 3 men. The presenting symptoms, tumor characteristics, operative management, postoperative complications, and survival rates were assessed for each patient. RESULTS The median patient age was 59 years (quartile [Q]1, 52 years; Q3, 68 years). The median tumor size was 7.0 cm (Q1, 6 cm; Q3, 12 cm). The median mitotic rate was 6 per 10 high-power fields (Q1, 2.5; Q3, 15.5). All 13 patients underwent grossly negative tumor resection, with 9 (69%) having microscopically negative margins (R0). No patient had lymph node involvement. The IVCs were managed with ligation in four patients for tumors already occluding the IVC and bovine pericardial patch angioplasty in seven patients or primary repair in two patients for patent IVCs. Concomitant right nephrectomy was performed in seven patients. Left renal vein ligation was performed in three patients, but no left nephrectomies were performed. Significant postoperative complications included one patient with lower extremity compartment syndrome, two patients with severe leg swelling, and one patient with arm swelling. The 30-day mortality rate was zero. Using the Kaplan-Meier product limit method, disease-specific survival was estimated to be 93%. CONCLUSIONS Surgical resection is a feasible and effective oncologic treatment option for patients with IVC leiomyosarcoma. The IVC can be safely managed by ligation, primary repair, or patch angioplasty, depending on the prior patency of the IVC.
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Affiliation(s)
| | - Sarah Jane Commander
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Dan G Blazer
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Young Kim
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kevin W Southerland
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Zachary F Williams
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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Castellanos LD, Tabbara MM, Livingstone AS, Salerno TA, Gonzalez J, Ciancio G. Unresectable leiomyosarcoma of the inferior vena cava with right atrium tumor thrombus: when to deem this tumor inoperable? A case report and literature review. Front Oncol 2024; 13:1331896. [PMID: 38282675 PMCID: PMC10811722 DOI: 10.3389/fonc.2023.1331896] [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] [Received: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024] Open
Abstract
Leiomyosarcomas (LMS) of the inferior vena cava (IVC) are a rare form of retroperitoneal malignancy, and their venous extension to the right atrium is an even rarer event. These tumors pose a unique surgical challenge and often require a multidisciplinary team-based approach for their surgical treatment. We present a case of a 68-year-old man with primary LMS of the IVC with a tumor thrombus extending into the right atrium that was initially deemed inoperable. After extensive neoadjuvant chemo-radiation with minimal tumor effect, the patient underwent en bloc surgical resection of the tumor along with removal of the infrarenal IVC and right kidney and adrenal without the need for cardiopulmonary bypass. This case demonstrates the successful management of a primary LMS of the IVC with right atrial extension using a multimodal approach of neoadjuvant chemo-radiation and en bloc surgical resection without cardiopulmonary bypass. This strategy may offer a curative option for selected patients with these rare and aggressive tumors, improving their survival and quality of life.
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Affiliation(s)
- Luis D. Castellanos
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Marina M. Tabbara
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Alan S. Livingstone
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Division of Surgical Oncology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Tomas A. Salerno
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Division of Cardiothoracic Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Javier Gonzalez
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Urology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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Tobe T, Terakawa T, Ueno Y, Sofue K, Hara T, Furukawa J, Teishima J, Nakano Y, Harada K, Fujisawa M. Cine magnetic resonance imaging in evaluating retroperitoneal leiomyosarcoma arising from the inferior vena cava. IJU Case Rep 2024; 7:30-33. [PMID: 38173447 PMCID: PMC10758901 DOI: 10.1002/iju5.12660] [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] [Received: 08/06/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Leiomyosarcoma of the inferior vena cava is associated with poor prognosis. Complete resection is the only curative treatment. We present a patient with this disease in whom cine magnetic resonance imaging was valuable in selecting the surgical strategy and mitigating invasiveness. Case presentation A 68-year-old woman presented with right-sided abdominal pain. Computed tomography revealed an 86 mm tumor in the right retroperitoneal space that extended into the inferior vena cava and reached superiorly to the right atrium. Percutaneous needle biopsy confirmed leiomyosarcoma. Cine magnetic resonance imaging demonstrated no adhesions between the tumor and the upper segment of inferior vena cava wall, nor with the right atrial wall, indicating resectability. Radical tumor resection was successfully performed without requiring thoracotomy. Conclusion Cine magnetic resonance imaging appears to be useful in inferior vena cava leiomyosarcoma for evaluating adhesions between the tumor and vessel wall.
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Affiliation(s)
- Taisuke Tobe
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Tomoaki Terakawa
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Yoshiko Ueno
- Department of RadiologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Keitaro Sofue
- Department of RadiologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Takuto Hara
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Junya Furukawa
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Jun Teishima
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Yuzo Nakano
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
| | - Kenichi Harada
- Department of UrologyUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Masato Fujisawa
- Department of UrologyKobe University Graduate School of MedicineKobeHyogoJapan
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7
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Mandava A, Koppula V, Kandati M, Reddy AK, Abubacker ZA. Primary Leiomyosarcoma of Suprahepatic Inferior Vena Cava with Metastases. Indian J Nucl Med 2024; 39:63-65. [PMID: 38817723 PMCID: PMC11135366 DOI: 10.4103/ijnm.ijnm_130_23] [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: 11/23/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 06/01/2024] Open
Abstract
A 67-year-old female presented with shortness of breath, weight loss, abdomen, and back pain for 2 months. Ultrasound of the abdomen revealed multiple focal liver lesions. 18F-Fluorodeoxyglucose whole-body positron emission tomography/computed tomography revealed a hypermetabolic lesion in the suprahepatic inferior vena cava extending into the right atrium. Multiple hypermetabolic lesions were seen in liver, bones, and abdominal lymph nodes, suggestive of metastases. Histopathology and immunohistochemistry of the lesions revealed it to be metastatic leiomyosarcoma.
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Affiliation(s)
- Anitha Mandava
- Department of Radiodiagnosis, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Veeraiah Koppula
- Department of Radiodiagnosis, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Meghana Kandati
- Department of Radiodiagnosis, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Arvind Kumar Reddy
- Department of Radiodiagnosis, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Zakir Ali Abubacker
- Department of Nuclear Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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8
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Ahmed S, Kumar NAN, Palod A, Bishnoi AK. Parietal Peritoneum Interposition Tube Graft as an Autologous Substitute for the Reconstruction of Inferior Vena cava Following Resection of Retroperitoneal Sarcoma. Indian J Surg Oncol 2023; 14:727-731. [PMID: 37900651 PMCID: PMC10611635 DOI: 10.1007/s13193-023-01768-y] [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: 02/13/2023] [Accepted: 05/04/2023] [Indexed: 10/31/2023] Open
Abstract
Complete resection of large retroperitoneal tumors often requires vascular resection and reconstruction, which is frequently performed using prosthetic grafts. We report our experience with inferior vena cava reconstruction utilizing a large peritoneal interposition tube graft performed during en bloc resection of retroperitoneal sarcoma and multiorgan resection. This study aimed to increase the awareness of surgical oncologists about the venous reconstruction technique using a large autologous peritoneal graft. An elderly male presented to our cancer center with a history of persistent abdominal pain. The computed tomography (CT) scan reported a large retroperitoneal mass involving the right kidney and the inferior vena cava (IVC). En bloc tumor resection with right nephrectomy and resection of the IVC extending from just above the bifurcation up to the origin of the renal veins was done. IVC reconstruction was performed using autologous parietal peritoneum tube graft. Harvesting the peritoneum and fashioning a large peritoneal tube graft was challenging. Post-operatively, the patient recovered without any complications and was discharged on oral anticoagulants. The CT scan during the follow-up visit at 6 months revealed that the IVC graft was patent with a good flow. Autologous peritoneal grafts are a safe, valid, and readily available option for venous reconstruction.
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Affiliation(s)
- Sameer Ahmed
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104 India
| | - Naveena A. N. Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104 India
| | - Akhil Palod
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104 India
| | - Arvind Kumar Bishnoi
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104 India
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Goodsell KE, Sharib JM, Pillarisetty VG, Sham JG. Leiomyosarcoma of the inferior vena cava: An uncommon malignancy requiring unique reconstructive approaches. Am J Surg 2023; 226:286-289. [PMID: 36959023 DOI: 10.1016/j.amjsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/11/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
Surgery is considered for patients without metastatic disease and with resectable primary tumor. Pre-operatively, high quality imaging is reviewed to determine the likely extent of resection, specifically including the need for potential en-bloc resection of adjacent organs. In cases where up-front surgical approach would expose the patient to excessive morbidity (such as bilateral nephrectomy, multi-visceral resection, or prohibitively high risk of positive margins), neoadjuvant chemotherapy and/or chemoradiotherapy is considered. Though data are sparse in LMS, a neoadjuvant regimen of doxorubicin and dacarbazine is typically considered for borderline resectable tumors at our institution; patients may be treated for up to 4 months with interval imaging every 2 months to evaluate for tumor response. Postoperatively, adjuvant systemic therapy or radiation may be considered for patients with positive surgical margins or high-grade tumors.
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Affiliation(s)
| | - Jeremy M Sharib
- University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Venu G Pillarisetty
- University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jonathan G Sham
- University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA.
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10
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Kang YJ, Farma J, Raut CP. Special clinical scenarios in RPS: Involvement of great vessels and pancreas and penetration across natural foramina. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1091-1101. [PMID: 36372616 DOI: 10.1016/j.ejso.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022]
Abstract
The primary treatment for retroperitoneal sarcomas is surgery. This requires a carefully planned, typically multivisceral, resection. A few complex scenarios that may arise include vascular involvement, pancreatic involvement, or herniation of the tumor into another compartment outside of the retroperitoneum. These scenarios must be anticipated before surgery to optimize preoperative preparation, minimize postoperative morbidity and mortality, and improve oncologic outcomes. Our aim is to highlight these clinically challenging anatomic presentations that can be encountered in patients with retroperitoneal sarcomas.
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Affiliation(s)
- Yun Jee Kang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
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11
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Ben Mahmoud A, Yakoubi C, Kacem S, Sebai A, Daghfous A, Kacem M. Inferior vena cava resection for a leiomyosarcoma: A case report. Int J Surg Case Rep 2023; 106:108304. [PMID: 37163797 DOI: 10.1016/j.ijscr.2023.108304] [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: 04/02/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Leiomyosarcomas of the inferior vena cava are scarce. Surgery is the only potential curative treatment. Such a surgery is complex and technically demanding, requiring a huge experience in both visceral and vascular surgery. Indeed, enlarged visceral resection may be needed to achieve a free tumor margins as the tumor may invade the duodenum, the head of the pancreas and the liver. Moreover, vascular reconstruction is mandatory which might be complex as both venal reins are usually invaded by the tumor like in our case below. CASE PRESENTATION A 53-year-old woman presented with abdominal vague pain. Imaging consisting in abdominal CT-scan with contrast and magnetic resonance angiography were suggestive of the diagnosis of leiomyosarcoma of the inferior vena cava. A surgical complete resection with free margins was conducted. A primary repair of the inferior vena cava and the right renal vein walls. End-to-side anastomosis with a polytetrafluorethylene (PTFE) prosthesis was mandatory to reconstruct the renal left vein to the inferior vena cava. Postoperative outcomes were uneventful. Pathology examination confirmed the diagnosis. DISCUSSION The optimal management of leiomyosarcoma of inferior vena cava is controversial. Surgery remains the cornerstone of treatment. However, not all patients are qualified for surgical resection. The prognosis depends on the early diagnosis and histology type. CONCLUSION The management of leiomyosarcomas of inferior vena cava requires a multidisciplinary consensus involving experienced surgery and oncology teams.
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Affiliation(s)
- Ahmed Ben Mahmoud
- Department of Surgery "A", La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Chaima Yakoubi
- Department of Surgery "A", La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Selma Kacem
- Department of Surgical Oncology, Salah Azaiez Institute, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Amine Sebai
- Department of Surgery "A", La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Amine Daghfous
- Department of Surgery "A", La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Montasser Kacem
- Department of Surgery "A", La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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12
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Not All Leiomyosarcomas Are the Same: How to Best Classify LMS. Curr Treat Options Oncol 2023; 24:327-337. [PMID: 36884163 DOI: 10.1007/s11864-023-01067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/09/2023]
Abstract
OPINION STATEMENT Leiomyosarcoma arises from smooth muscle and represents one of the most common soft tissue sarcomas. Despite aggressive multimodality care, over half of the patients will ultimately develop metastatic and incurable disease with a median survival of 12-18 months. At present, there is no standard system to classify leiomyosarcoma, which itself is a heterogeneous disease. Classification by tumor location is the most simplistic approach and is most frequently utilized in clinical practice. Tumor location impacts diagnosis (recognition pre-operatively versus at the time of surgery) as well as treatment (ability to completely resect with clear margins with minimal morbidity). While tumor location can impact prognosis, for example, extremity tumors would generally be considered as lower risk than inferior vena cava tumors, leiomyosarcoma can exhibit a heterogeneous behavior irrespective of tumor location. Specifically, some patients have rapidly progressing disease despite aggressive chemotherapy, while others display a more indolent course even in the metastatic setting. The pathogenic drivers of the heterogeneity observed in tumor behavior are not well understood. As we learn more about the molecular composition of leiomyosarcoma, various classification groups have been proposed as discussed here. Ultimately, it is unlikely that one variable will be adequate for tumor classification, and a combination of location and molecular composition will be necessary to develop appropriate risk stratification nomograms and treatment strategies.
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13
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BORGHI A, SCOTTO DI UCCIO A, GRONCHI A. Primary malignancy of the inferior vena cava, a review of surgical treatments and outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:649-663. [DOI: 10.23736/s0021-9509.22.12418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hampton D, Zayyat E, Macedo FI, Hook S. Leiomyosarcoma of the inferior vena cava presenting with bilateral lower extremity edema with comorbid sarcoidosis: A case report. Int J Surg Case Rep 2022; 99:107612. [PMID: 36115116 PMCID: PMC9568709 DOI: 10.1016/j.ijscr.2022.107612] [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: 08/17/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
We present a case of a 70-year-old female with Leiomyosarcoma (LMS) of the inferior vena cava (IVC). Although this is an extremely rare entity, in contradistinction, it is also the most common primary malignancy of the IVC [5]. The patient has a history of sarcoidosis, hypertension, diabetes mellitus type two, and chronic obstructive pulmonary disease (COPD). She presented with a complaint of bilateral lower extremity edema and was admitted where a computerized tomography (CT) scan of the abdomen and pelvis showed a large mass filling the IVC, a finding confirmed by magnetic resonance imaging. Radical resection of the retroperitoneal tumor was carried out including portions of the inferior vena cava with en bloc radical right nephrectomy and right adrenalectomy. The pathologic diagnosis of inferior venal caval leiomyosarcoma (IVC LMS) was made with positive immunostains for desmin, vimentin and smooth muscle actin. The rarity of this entity, clinical presentation along with concomitant sarcoidosis makes this an interesting case. Leiomyosarcoma of the inferior vena cava with bilateral lower extremity edema. The link between sarcoidosis and sarcoma that has yet to be determined. Sarcoidosis within lymph nodes mistakenly leading to higher tumor stage. Bilateral lower extremity edema secondary to tumor thrombus in the IVC.
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Affiliation(s)
- Dallas Hampton
- Medical Student, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| | - Elie Zayyat
- Department of Vascular Surgery, North Florida Regional Medical Center, Gainesville, FL 32605, USA.
| | - Francisco I Macedo
- Department of General Surgery, North Florida Regional Medical Center, Gainesville, FL 32605, USA.
| | - Sharon Hook
- Department of Pathology, North Florida Regional Medical Center, Gainesville, FL 32605, USA.
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15
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Kunte A, Patkar S, Goel M. Inferior Vena Cava (IVC) Resection Without Reconstruction for a Large IVC Leiomyosarcoma. J Gastrointest Surg 2022; 26:2014-2018. [PMID: 35581461 DOI: 10.1007/s11605-022-05349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/30/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Retroperitoneal tumours arising from the inferior vena cava (IVC) are rare tumours often requiring large vessel resection for complete surgical excision. Limited exposure to such tumours often discourages surgeons from offering surgical resection to these patients, depriving them of the only potentially curative modality. We present here the surgical technique for resection of a large IVC sarcoma without IVC reconstruction. METHODS A 53-year-old lady presented with a large retroperitoneal sarcoma encasing the infra-hepatic IVC with tumour thrombus extension into the hepatic cloaca as well as the left renal vein. Surgical resection was planned as the disease remained stable after 2 cycles of neoadjuvant chemotherapy with adriamycin and ifosfamide. RESULTS Complete surgical excision of the tumour was achieved by performing a resection of the entire length of infra-hepatic IVC and right kidney, without IVC reconstruction. Left renal vein was divided after careful preservation of a draining collateral. Tumour thrombus was extracted from the hepatic cloaca, and proximal IVC stump closure was achieved with preservation of right hepatic vein insertion. Total blood loss during the procedure was 2300 mL, and the patient recovered without compromise of renal function or development of lower limb oedema. CONCLUSION IVC resection without reconstruction can be safely performed for large retroperitoneal sarcomas involving major vascular structures. Familiarity with the retroperitoneal, retro-hepatic and supra-hepatic anatomy is paramount to achieving good surgical outcomes.
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Affiliation(s)
- Aditya Kunte
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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16
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Pérez-de-Villar JM, Arjona-Sanchez A, Rufián-Andujar B, Valenzuela-Molina F, Sánchez-Hidalgo JM, Rodriguez-Ortiz L, Casado-Adam A, Viyuela-García C, Rufián-Peña S, Caro-Cuenca T, Moreno-Vega A, Briceño-Delgado J. Surgical treatment of vena cava leiomyosarcomas: Series of cases in a referral center and literature review. Cir Esp 2022; 100:481-487. [PMID: 35597419 DOI: 10.1016/j.cireng.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Primary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles. METHODS A series of 6 cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out. RESULTS Optimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavorraphy was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3 ± 9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9 ± 2 months. CONCLUSION The diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease.
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Affiliation(s)
| | | | | | | | | | | | - Angela Casado-Adam
- Unidad de Cirugía Oncológica, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - Teresa Caro-Cuenca
- Unidad de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Alberto Moreno-Vega
- Unidad de Oncología Médica, Hospital Universitario Reina Sofía, Córdoba, Spain
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17
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Silva TA, Buonfiglio VB, Sadi MV. "Leiomyosarcoma of the inferior vena cava and vascular reconstruction''. Urology 2022; 168:e15-e17. [PMID: 35908743 DOI: 10.1016/j.urology.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/10/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
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18
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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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Tulahong A, Tuxun T, Yao G, Fulati X, Apaer S, Anweier N, Wu J, Aierken A, Zhao JM, Bai L, Li T. Surgical management strategy for leiomyosarcoma of Zone I-II inferior vena cava: A case series. Medicine (Baltimore) 2022; 101:e29326. [PMID: 35665732 PMCID: PMC9276320 DOI: 10.1097/md.0000000000029326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/01/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Leiomyosarcoma of inferior vena cava (IVC) is a rare clinical entity with severe vascular involvement. Surgical management of leiomyosarcoma is still challenging. METHODS This a retrospective study of consecutive patients referred to our hospital from January 2017 to June 2019. Depending on the anatomical site of affected IVC, leiomyosarcomas were categorized into zone I-II. The clinical data including baseline information, surgical parameters, peri-operative management, short- and mid-term outcomes were observed. RESULTS Four patients with leiomyosarcoma of zone I-III underwent radical resection without intraoperative mortality. Prosthetic grafts were interpositioned in all patients to instruct vena cava. Renal vein reconstruction was perfumed in two patients due to involvement to renal veins. Median blood loss was 450 mL (200-600 mL), median operative time was 215 minutes (150-240 minutes). No Clavien-Dindo IIIa or higher complication was observed. No organ dysfunction and recurrence were observed with median follow-up of 25.5 months. CONCLUSIONS Curative resection of zone I-II leiomyosarcoma is associated with longer survival in selected cases, en-bloc resection with complex vascular reconstruction could be considered.
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Affiliation(s)
- Aisikeer Tulahong
- 2nd Oncology Department, Center of Oncology, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Tuerhongjiang Tuxun
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Gang Yao
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Xiapukati Fulati
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Shadike Apaer
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Nuerzhatijiang Anweier
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Jing Wu
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Amina Aierken
- Center of Health Management, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Jin-Ming Zhao
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Lei Bai
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Tao Li
- Department of Liver & Laparoscopic Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi
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20
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Pan J, Qiu CY, He YY, Xue X, Li DL, Tian L, Cheng F, Wu ZH, Zhang HK. A 10-year experience of leiomyosarcoma of the inferior vena cava. Phlebology 2022; 37:572-578. [PMID: 35570826 DOI: 10.1177/02683555221101706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Leiomyosarcoma of the inferior vena cava (IVC) is rare. The study reviewed patients with IVC leiomyosarcoma in our hospital in the past ten years. METHODS Twenty patients diagnosed with IVC leiomyosarcoma between October 2010 and October 2020 were enrolled. Their clinical manifestations, treatments, and follow-up results were analyzed. RESULTS The sarcoma was located in the lower IVC segment in six patients, with 13 in the middle and one in the upper IVC segment. Eighteen patients underwent R0 resection. After resection, 16 patients (80%) had primary repair of the IVC, while four patients underwent ligation. During a mean follow-up of 37.7 months, seven patients died due to tumor metastasis, four patients were alive with the tumor recurrence and other nine patients were alive without recurrence. CONCLUSION The management of the IVC after tumor resection depended on the tumor location and size. R0 resection provided a chance for long term survival.
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Affiliation(s)
- Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Chen-Yang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Yang-Yan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Xing Xue
- Department of Radiology, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Dong-Lin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Fei Cheng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Zi-Heng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Hong-Kun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
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21
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Borghese O, Pisani A, Dubrez J, Di Centa I. Treatment outlines for the management of primary leiomyosarcoma of the inferior vena cava. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:65-70. [PMID: 35691665 DOI: 10.1016/j.jdmv.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
Primary venous Leiomyosarcoma (LMSs) are extremely rare tumours with poor survival rates. Surgery is currently the only potentially curative therapy in non-metastatic disease, but it consists in challenging interventions. The authors report the experience of one single centre in the treatment of LMS and a literature overview focusing on the diverse methods of vessels repair. Outcomes achieved are also outlined.
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Affiliation(s)
- Ottavia Borghese
- Sapienza University, Rome, Italy; Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France.
| | - Angelo Pisani
- Sapienza University, Rome, Italy; Department of Cardiovascular Surgery, Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Julien Dubrez
- Department of Gastrointestinal Surgery, Foch Hospital, Suresnes, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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22
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Wang S, Li Y, Yang Q, Zhang X, Cheng Y, Li Z, Wang J, Zeng Q. Surgery Treatment of Primary Tumors of the Inferior Vena Cava. Front Med (Lausanne) 2022; 9:770967. [PMID: 35308557 PMCID: PMC8924448 DOI: 10.3389/fmed.2022.770967] [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: 10/07/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background Primary tumor of the inferior vena cava is a rare tumor, which arises from the smooth muscle of vascular walls. Surgery appears the only curative treatment. However, the optimal surgical methods and surgical management are not well-studied. In this article, we reviewed the successful treatment experience of patients in our center who had resection of primary tumor of the inferior vena cava and reviewed the relevant literature. Methods Four cases of patients who undergoing initial resection of primary tumors of the inferior vena cava from September 2017 to August 2021 in the Second Affiliated Hospital of Nanchang University were screened and followed up. They were discussed and cases reported in this field were reviewed. Results Among the four patients, three of them were female. The median age of the disease is 53.75 years (range 45–60 years). After surgical treatment, tumors were removed in all patients, and some patients had reconstruction of inferior vena cava. There were no disease-specific deaths, no serious complications, and no recurrence during follow-up in these cases. Conclusions Careful preoperative examination, correct surgical treatment methods, and multidisciplinary collaboration can lead to safe and successful operations, which improve the survival rate of patients.
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Affiliation(s)
- Shizhi Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuqiu Li
- Queen Mary College of Nanchang University, Nanchang, China
| | - Qijun Yang
- Queen Mary College of Nanchang University, Nanchang, China
| | - Xue Zhang
- Queen Mary College of Nanchang University, Nanchang, China
| | - Yunqi Cheng
- Queen Mary College of Nanchang University, Nanchang, China
| | - Zimeng Li
- School of Public Health, Nanchang University, Nanchang, China
| | - Jingyi Wang
- School of Public Health, Nanchang University, Nanchang, China
| | - Qingfu Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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23
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Goel M, Mohan A, Patkar S, Gala K, Shetty N, Kulkarni S, Dhareshwar J. Leiomyosarcoma of inferior vena cava (IVC): do we really need to reconstruct IVC post resection? Single institution experience. Langenbecks Arch Surg 2022; 407:1209-1216. [PMID: 35022833 DOI: 10.1007/s00423-021-02408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) leiomyosarcomas (LMS) are a rare group of retroperitoneal tumors. R0 surgical resection is the only curative modality of treatment. IVC resection for retroperitoneal sarcoma is a complex surgery with no definitive guidelines for reconstruction. METHODS Retrospective review of all patients who underwent surgical resection of primary leiomyosarcoma of the IVC requiring resection from 2010 to 2020 at our tertiary care center was performed. RESULTS Among 24 patients who required IVC resection for LMS, only 7 (29%) required reconstruction of IVC. According to Clavien-Dindo classification, there was one grade 3 or more morbidity and 1 post-operative mortality. Seventeen patients underwent R0 resection whereas 7 patients had R1 resection on final histopathology. At a median follow-up of 25 months (range 8-91 months), the median OS was 40 months with median DFS of 28 months. Two patients presented with local recurrence while 13 patients developed systemic recurrence on follow-up. CONCLUSION Careful preoperative multidisciplinary planning can make IVC resection without reconstruction feasible with acceptable perioperative morbidity, mortality, and oncological outcomes for IVC LMS.
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Affiliation(s)
- Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Anand Mohan
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India.
| | - Kunal Gala
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jayesh Dhareshwar
- Department of Vascular Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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24
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Vena Cava and Pancreatic head En Bloc Resection for an Invasive Inferior Vena Cava Leiomyosarcoma in a Liver Transplant Patient. Clin Res Hepatol Gastroenterol 2021; 45:101609. [PMID: 33662783 DOI: 10.1016/j.clinre.2020.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND De novo neoplasms are one of the major causes of death in patients after the first year of liver transplantation. The occurrence of sarcomas is extremely rare and the survival is often poor. However, early diagnosis and radical surgical treatment, may benefit some select liver transplant patients. METHOD We describe the case of a liver transplant patient who developed a locally advanced inferior vena cava (IVC) leiomyosarcoma, who underwent radical surgical treatment with resection of the IVC associated with duodenopancreatectomy, right nephrectomy, and IVC reconstruction. We address aspects of the diagnosis and surgical strategy. CONCLUSION This case report illustrates that IVC and multivisceral resections may be feasible and safe in highly selected liver transplant recipients. Major surgery should not be excluded as treatment option in an immunosuppressed liver transplant patient.
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25
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Wang MX, Menias CO, Elsherif SB, Segaran N, Ganeshan D. Current update on IVC leiomyosarcoma. Abdom Radiol (NY) 2021; 46:5284-5296. [PMID: 34415408 DOI: 10.1007/s00261-021-03256-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022]
Abstract
Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare soft tissue sarcoma associated with poor prognosis. Patients are often asymptomatic or present with nonspecific abdominal symptoms, which delays initial diagnosis and contributes to poor oncologic outcome. Key imaging modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Characteristic imaging features include imperceptible caval lumen, dilation of the IVC, heterogeneous enhancement of the tumor, and development of extensive collateral circulation. Surgical resection is the mainstay of treatment, while chemotherapy and/or radiation may serve as therapy adjuncts. This article reviews the pathology, clinical findings, imaging features and management of IVC leiomyosarcoma.
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Affiliation(s)
- Mindy X Wang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Sherif B Elsherif
- Department of Radiology, UF College of Medicine-Jacksonville, 653-1 8th St W, Jacksonville, FL, 32209, USA
| | - Nicole Segaran
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Dhakshinamoorthy Ganeshan
- Unit 1473, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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26
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Zhou M, Javadi C, Charville GW, Bui NQ, Harris EJ, Poultsides GA, Norton JA, Visser B, Lee B, Dua MM, Ganjoo KN. Surgical resection of leiomyosarcoma of the inferior vena cava: A case series and literature review. Surg Oncol 2021; 39:101670. [PMID: 34710646 DOI: 10.1016/j.suronc.2021.101670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/21/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We review our institution's experience in treating leiomyosarcomas involving the inferior vena cava, and we offer guidance on the management. METHODS A text-based search was performed to identify all patients who underwent surgical resection between January 2002 and October 2020. Clinicopathologic data, intraoperative variables, and outcomes were extracted from chart review. RESULTS Twelve of 16 patients (75%) had localized disease; the remaining had limited metastatic disease. Seven of 16 patients (44%) received neoadjuvant chemotherapy or radiation; three patients had partial responses, and four patients had stable disease using RECIST 1.1 criteria. IVC reconstruction was performed in 14 of 16 patients (88%); IVC was ligated for the remaining two patients. Half of all patients had R0 resection on final pathology; the remaining had R1 resections. Progression-free survival (PFS) and overall survival (OS) were not statistically different between patients with R0 and R1 resection. Median PFS was 1.8 years (95% CI 0.89 - not reached); median OS was 6.5 years (1.8 - not reached). Only one patient (6%) experienced local disease recurrence; 4 of 16 patients (25%) experienced disease recurrence distally without local recurrence. CONCLUSIONS Resection of IVC leiomyosarcomas at a sarcoma referral center with experience in vascular reconstruction can lead to many years of recurrence-free survival. Surgical resection should be offered to patients with a low volume of metastatic disease to reduce local complications from the primary tumor, many of which exert significant mass effect on surrounding organs. For patients with metastatic disease or large, high-risk tumors, neoadjuvant chemotherapy can provide a biologic test of disease stability prior to resection.
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Affiliation(s)
- Maggie Zhou
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Greg W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nam Q Bui
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E John Harris
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | | | - Jeffrey A Norton
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Brendan Visser
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Byrne Lee
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Monica M Dua
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Kristen N Ganjoo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Saikia J, Rastogi S, Barwad A, Dhamija E, Pandey R, Bhoriwal S, Deo S, Kumar S. A systematic review of the current management approaches in leiomyosarcoma of inferior vena cava-Results from analysis of 118 cases. Asian Cardiovasc Thorac Ann 2021; 30:349-363. [PMID: 34672808 DOI: 10.1177/02184923211049911] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary intravenous leiomyosarcomas are rare vascular tumors with aggressive disease biology. The diagnosis and management have been challenging as little data exist from large databases. METHODS A literature search was done to identify all cases of primary leiomyosarcomas in the last five years. Clinicopathological features and management strategies were evaluated. RESULTS The median age was 53 years, predominantly females (2.5:1), presenting as metastases in up to 12.1% cases. Most tumors were locally advanced with a median size of 10cm. Inferior vena cava involvement from renal veins to infrahepatic veins remains the most frequent site (57.1%cases) while nearly half (52.8%) proceeded for surgery without histological proof. Most patients could undergo upfront resection (88.0%) with few patients receiving neoadjuvant chemotherapy (4.3%) or neoadjuvant radiotherapy (2.2%). Significant multivisceral resections included right nephrectomy (41.3%), liver resection (25.7%) and left nephrectomy (2.2%). Most patients (91.8%) needed an inferior vena cava graft placement with remarkable microscopically negative margins (85.5% cases). Doxorubicin and ifosfamide were the most frequently used combination chemotherapy regimens in both pre and postoperative settings with partial responses. The median overall and disease free survival among operated patients was 60 months and 28 months respectively. In multivariate analysis large tumor, extensive inferior vena cava involvement, and need for adjuvant chemotherapy appeared significant predictors for overall survival. CONCLUSIONS Aggressive upfront surgical resection with clear margin remains the key for long-term survival. Doxorubicin-based regimens were preferred as neoadjuvant chemotherapy while adjuvant treatment with chemotherapy, radiotherapy, or both may be considered in high-risk patients.
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Affiliation(s)
- Jyoutishman Saikia
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Suryanarayana Deo
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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Sheaffer WW, Davila VJ, Mendes BC, Meltzer AJ, Stone WM, Soh IY, Truty MJ, Nagorney DM, Money SR, Bower TC. Surgical and reconstructive outcomes in primary venous leiomyosarcoma. J Vasc Surg Venous Lymphat Disord 2021; 10:901-907. [PMID: 34352417 DOI: 10.1016/j.jvsv.2021.07.010] [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: 02/21/2020] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Primary venous leimyosarcomas (PVL) are rare and pose challenges in surgical management. This study evaluates the clinical outcomes and identifies predictors of survival in our surgical series of PVL. METHODS A retrospective review was performed of patients who had resection of PVL at three centers between 1990-2018. Patient demographics, comorbidities, intraoperative data, survival, and graft related outcomes were recorded. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS Seventy patients with a diagnosis of PVL were identified between 1990 and 2018. Fifty-four patients (77%) had PVL of the IVC and 16 (23%) had peripheral PVL. Mean follow up for the series was 55.0 months (range 1-217 months). Fifty one patients (96%) with IVC PVL needed caval reconstruction and 3 (4%) had resection only. There were no deaths within thirty days of surgery. Five patients (9%) required early re-intervention including one (2%) IVC stent. Sixteen peripheral PVL were identified. Eight patients (50%) had venous reconstructions performed and 8 (50%) had the vein resected without reconstruction. There were no deaths within thirty days. Five year survival was 57.5% for IVC PVL and 70.0% for peripheral PVL . Kaplan-Meier survival analysis for IVC and peripheral PVL revealed no difference in overall survival (p = 0.624) at 5 years. CONCLUSIONS PVL is a rare and aggressive disease even with surgical resection. We found no difference in survival between IVC and peripheral lesions suggesting aggressive management is warranted for PVL of any origin. Management of PVL requires a multidisciplinary approach to provide patients with the best long term outcomes.
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Affiliation(s)
- William W Sheaffer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054.
| | - Victor J Davila
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Bernardo C Mendes
- Mayo Clinic Rochester Division of Vascular Surgery, 200 First St. SW, Rochester, MN 55905
| | - Andrew J Meltzer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - William M Stone
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Ina Y Soh
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Mark J Truty
- Mayo Clinic Rochester Department of General Surgery Subspecialties, 200 First St. SW, Rochester, MN 55905
| | - David M Nagorney
- Mayo Clinic Rochester Department of General Surgery Subspecialties, 200 First St. SW, Rochester, MN 55905
| | - Samuel R Money
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Thomas C Bower
- Mayo Clinic Rochester Division of Vascular Surgery, 200 First St. SW, Rochester, MN 55905
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Nooromid M, De Martino R, Squizzato F, Benedetto F, De Caridi G, Chou EL, Conrad MF, Pantoja J, Abularrage C, Sorber R, Garcia-Ortega DY, Luna-Ortiz K, Eichler C, Zarkowsky D, Chia M, Kalluri A, Cohnert T, Szeberin Z, Grotemeyer D, Shalhub S, Fagg D, Jackson MJ, Charlton-Ouw K, Gombert A, Jacobs M, Boyd A, Motaganahalli R, Uceda D, Woo K, Eskandari MK. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. J Vasc Surg Venous Lymphat Disord 2021; 10:617-625. [PMID: 34271247 DOI: 10.1016/j.jvsv.2021.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Primary leiomyosarcoma of the inferior vena cava (IVC) is best managed with surgical resection when technically feasible. However, consensus is lacking regarding the best choice of conduit and reconstruction technique. The aim of the present multicenter study was to perform a comprehensive assessment through the VLFDC (Vascular Low Frequency Disease Consortium) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC. METHODS A multicenter, standardized database review of patients who had undergone surgical resection and reconstruction of the IVC for primary leiomyosarcoma from 2007 to 2017 was performed. The demographics, periprocedural details, and postoperative outcomes were analyzed. RESULTS A total of 92 patients (60 women and 32 men), with a mean age of 60.1 years (range, 30-88 years) were treated. Metastatic disease was present in 22%. The tumor location was below the renal veins in 49 (53%), between the renal and hepatic veins in 52 (57%), and above the hepatic veins in 13 patients (14%). The conduits used for reconstruction included ringed polytetrafluoroethylene (PTFE; n = 80), nonringed PTFE (n = 1), Dacron (n = 1), autogenous vein (n = 1), bovine pericardium (n = 4), and cryopreserved tissue (n = 5). Complete R0 resection was accomplished in 73 patients (79%). In-hospital mortality was 2%, with a median length of stay of 8 days. The primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 and 5 years, respectively, compared with 73% at 1 and 5 years for the non-PTFE reconstructed IVCs. The overall 1-, 3-, and 5-year survival for the entire cohort were 94%, 86%, and 65%, respectively CONCLUSIONS: The findings from our multi-institutional study have demonstrated that complete en bloc resection of IVC leiomyosarcoma with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. A ringed PTFE graft was the most commonly used conduit for caval reconstruction, yielding excellent long-term primary patency.
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Affiliation(s)
- Michael Nooromid
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Randall De Martino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Francesco Squizzato
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Filippo Benedetto
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Giovanni De Caridi
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Elizabeth L Chou
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Joe Pantoja
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Christopher Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Dorian Yarih Garcia-Ortega
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Kuauhyama Luna-Ortiz
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Charles Eichler
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Devin Zarkowsky
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Matthew Chia
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Aravind Kalluri
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tina Cohnert
- Department of Vascular Surgery, Graz Medical University, Graz, Austria
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Dirk Grotemeyer
- Department of Vascular Surgery, Hopitaux Robert Schuman, Hopital Kirchberg, Luxembourg City, Luxembourg
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Damen Fagg
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Mark J Jackson
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kristofer Charlton-Ouw
- Department of Clinical Sciences, University of Houston College of Medicine and Gulf Coast Vascular, HCA Houston Healthcare, Gulf Coast Division, Houston, Tex
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - April Boyd
- Division of Vascular Surgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Domingo Uceda
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Silverman J, Pencovich N, Mayer C, Volkov A, Eshkenazi R, Nachmany I. Giant leiomyosarcoma of the inferior vena cava necessitating extended liver resection: A case report and review of the literature. J Surg Case Rep 2021; 2021:rjab271. [PMID: 34168858 PMCID: PMC8219390 DOI: 10.1093/jscr/rjab271] [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: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 11/14/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour of smooth muscle origin. It commonly presents with non-specific symptoms including abdominal pain, distention, and lower extremity edema. Surgical resection with macroscopically clear margins is the only potential curative treatment for the disease. Here we present the case of a previously healthy 38-year-old woman with a subacute one-month increase of a four-year slowly progressive right sided abdominal pain and back pain. Imaging revealed a 14.5x12x15cm mass in the right hepatic lobe causing mass effect on adjacent abdominal and retroperitoneal organs, and involving the retrohepatic IVC. En-bloc resection of the right hemi-liver, most of segment four, the caudate lobe, and approximately a 10 cm section of the retrohepatic IVC, along with IVC reconstruction, was performed. Histologic examination revealed the diagnosis of a high grade leiomyosarcoma.
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Affiliation(s)
- Jacob Silverman
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Niv Pencovich
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Chen Mayer
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Alexander Volkov
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Rony Eshkenazi
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
| | - Ido Nachmany
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer 52621, Faculty of Medicine, Tel-Aviv University, Israel
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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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Pérez-de-Villar JM, Arjona-Sanchez A, Rufián-Andujar B, Valenzuela-Molina F, Sánchez-Hidalgo JM, Rodriguez-Ortiz L, Casado-Adam A, Viyuela-García C, Rufián-Peña S, Caro-Cuenca T, Moreno-Vega A, Briceño-Delgado J. Surgical treatment of vena cava leiomyosarcomas: Series of cases in a referral center and literature review. Cir Esp 2021; 100:S0009-739X(21)00179-2. [PMID: 34148656 DOI: 10.1016/j.ciresp.2021.05.001] [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: 04/15/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Primary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles. METHODS A series of six cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out. RESULTS Optimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavography was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3±9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9±2 months. CONCLUSION The diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease.
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Affiliation(s)
| | | | | | | | | | | | - Angela Casado-Adam
- Unidad de Cirugía Oncológica, Hospital Universitario Reina Sofía, Córdoba, España
| | | | | | - Teresa Caro-Cuenca
- Unidad de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España
| | - Alberto Moreno-Vega
- Unidad de Oncología Médica, Hospital Universitario Reina Sofía, Córdoba, España
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Rusu CB, Gorbatâi L, Szatmari L, Koren R, Bungărdean CI, Feciche BO, Bumbuluţ C, Andraş IM, Rahotă R, Telecan T, Coman I, Rath-Wolfson L, Crişan N. Leiomyosarcoma of the inferior vena cava. Our experience and a review of the literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:227-233. [PMID: 32747914 PMCID: PMC7728114 DOI: 10.47162/rjme.61.1.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignant tumor, accounting for 2% of all LMSs. Less than 400 cases have been reported in literature. Computed tomography (CT) is the most accurate imaging method in assessing the location of the tumor within the IVC and magnetic resonance imaging (MRI) accurately identifies its extent and the potential for surgical resection. We present the case of a patient with inferior vena cava leiomyosarcoma (IVCL), for whom the pathological diagnosis was different from the initially expected one, the tumor appearance on pre-operative imaging mimicking renal cell carcinoma. The intraoperative difficulty of approaching renal hilum and IVC was a factor suggesting the vascular origin of the tumor, which was confirmed at pathological analysis. The extensive defect in the IVC after tumor excision led to the decision of complete transverse suturing of IVC, as significant collateral venous circulation was already present. Because IVCL is a rare disease, there is scarce data regarding the prognosis and treatment options. Long-term survival depends on the extent of the surgery. The need of vascular reconstruction is not always mandatory. Despite high recurrence rates, no consensus regarding adjuvant treatment exists yet. A multidisciplinary approach including surgical oncologists and vascular surgeons is mandatory to achieve the best patient outcomes. Perioperative planning, coordination and adherence to oncological techniques are critical.
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Affiliation(s)
- Cristian Bogdan Rusu
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Municipal Clinical Hospital, Cluj-Napoca, Romania;
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Tuxun T, Li T, Apaer S, He YB, Bai L, Gu SS, Wang ZP, Huo Q, Wang J, Zhao JM. Ex Vivo Liver Resection and Autotransplantation as Surgical Option for Zone II-III Leiomyosarcoma of IVC: A Case Report and Literature Review. Front Oncol 2021; 11:690617. [PMID: 34178689 PMCID: PMC8226245 DOI: 10.3389/fonc.2021.690617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
We report the first documented case of leiomyosarcoma at zone II-III of inferior vena cava with thrombi in three hepatic veins undergoing ex vivo liver resection and autotransplantation (ELRA) and hepatic veins thrombectomy. A 33-year-old female patient presented with abdominal distention and lower extremities edema. Abdominal wall varicosis and shifting dullness were positive on physical examination. Her liver function was classified as Child-Pugh B and a solid tumor at retro-hepatic vena cava extending to right atrium with thrombi in three hepatic veins were confirmed. The diagnosis of leiomyosarcoma with Budd-Chiari syndrome was highly suspected with preoperative ultrasound, echocardiogram, CT scan, and three-dimensional reconstruction. A zone II-III leiomyosarcoma of IVC origin was confirmed at surgery and ex vivo liver resection and autotransplantation, and hepatic vein thrombectomy with atrial reconstruction were performed under cardiopulmonary bypass (CPB). Operative time, anhepatic time, and CPB time were 12 h, 128 min, and 84 min, respectively. The patients experienced post-operative liver dysfunction and was cured with conservative therapy. Hepatic recurrence two years after surgery was managed with radiofrequency. The patient was alive with liver metastasis three years after surgery. Despite being regarded as an extremely aggressive procedure, ELRA could be considered in the treatment of advanced leiomyosarcoma with Budd-Chiari syndrome and hepatic vein thrombi.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tao Li
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shadike Apaer
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Biao He
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lei Bai
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shen-Sen Gu
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhi-Peng Wang
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Huo
- Department of Cardiac Surgery, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jiang Wang
- Department of Anesthesiology, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jin-Ming Zhao
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Local Recurrence Rates of Skin Tumors After Resection With Complete Circumferential Peripheral and Deep Margin Assessment-Identification of High-Risk Entities. Dermatol Surg 2021; 47:e31-e36. [PMID: 33565775 DOI: 10.1097/dss.0000000000002431] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found. OBJECTIVE The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification. PATIENTS AND METHODS We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and H&E staining. Re-excisions were performed until the tumor was completely removed. RESULTS Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease. CONCLUSION Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.
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Gaignard E, Bergeat D, Robin F, Corbière L, Rayar M, Meunier B. Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection? World J Surg 2021; 44:3537-3544. [PMID: 32445073 DOI: 10.1007/s00268-020-05602-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inferior vena cava leiomyosarcoma (IVCL) is a rare tumor with a poor prognosis, and its surgical resection remains a challenge. To date, surgery is the only potentially curative treatment for IVCL with a 5-year survival rate of 55%. The main challenge is to combine oncological surgery with clear margins and vascular reconstruction of the inferior vena cava (IVC). In this review, we discuss the different approaches to vascular reconstruction after IVCL resection, using a prosthetic or autologous patch, direct suture or simple ligation without IVC reconstruction. The reconstruction of IVC depends of tumor location and its extension. We recommend no reconstruction if venous collaterality is well-established. When vascular reconstruction is required, we prefer prosthetic PTFE graft. These patients should be referred to high-volume centers with a multidisciplinary team of sarcoma surgeons with cardiothoracic, vascular and hepatic specialties.
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Affiliation(s)
- Elodie Gaignard
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France.
- Université de Rennes, 35000, Rennes, France.
| | - Damien Bergeat
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
- UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France
| | - Fabien Robin
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
- UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France
| | - Lisa Corbière
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| | - Michel Rayar
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
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Tran V, Slavin J. Soft Tissue Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Das SAP, Paleela PS, Kuppuswamy MK, Venugopal B, Krishnan E. Retrohepatic Caval Leiomyosarcoma Antesitum Resection: A Case Report and a Review of Literature. J Clin Exp Hepatol 2021; 11:742-746. [PMID: 34866851 PMCID: PMC8617528 DOI: 10.1016/j.jceh.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava (IVC-LMS) is a rare mesenchymal tumor arising from the tunica media. In this report, we describe the antesitum resection without inferior vena cava (IVC) reconstruction of retrohepatic IVC-LMS. To our knowledge, this is the first report of antesitum resection for IVC-LMS from India. A 51-year-old lady presented with features of Budd-Chiari syndrome and abdominal pain. Evaluation showed the tumor arising from IVC extending from above the renal veins and upto the subdiaphragmatic IVC. Blood investigations were normal with a positron emission tomography scan showing no metastatic disease. Antesitum, in situ resection of the IVC-LMS was performed. The patient recovered well postoperatively without renal or hepatic issues. Radical resection of IVC-LMS offers a chance for cure even in locally advanced status. Experience in complex liver resection and liver transplantation has made the resection of such tumors possible and safe.
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Affiliation(s)
- S. Aurobindo P. Das
- Center for Liver Disease and Transplantation, Apollo Hospitals, Chennai, India
| | - Pardha S. Paleela
- Center for Liver Disease and Transplantation, Apollo Hospitals, Chennai, India
| | | | - Balaji Venugopal
- Department of Vascular Surgery, Apollo Hospitals, Chennai, India
| | - Elankumaran Krishnan
- Center for Liver Disease and Transplantation, Apollo Hospitals, Chennai, India,Address for correspondence. Elankumaran Krishnan, Center for Liver Disease and Transplantation, Apollo Hospitals, Chennai, India.
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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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Aiba M, Kigawa I. Long-Term Survival in a Case of Primary Leiomyosarcoma of the Inferior Vena Cava in Which PET-CT Follow-up Was Useful. Ann Vasc Dis 2020; 13:351-354. [PMID: 33384746 PMCID: PMC7751081 DOI: 10.3400/avd.cr.20-00056] [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] [Indexed: 11/26/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignancy, but has been found more frequently with recent advances in diagnostic imaging. Local recurrence and metastases are frequent with this pathology, and prognosis is poor. We report a case of a patient with leiomyosarcoma of the IVC surviving for >10 years after the first resection despite local recurrence and two metastatic recurrences to the pancreas and liver, with successful excisions following early detection on positron emission tomography-computed tomography.
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Affiliation(s)
- Masahiro Aiba
- Department of Cardiovascular Surgery, Totsuka Kyoritsu Second Hospital
| | - Ikutaro Kigawa
- Department of Cardiovascular Surgery, Totsuka Kyoritsu Second Hospital
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Zhou X, Wang M, Li S, Cai H, Liang L, Li ZP, Feng ST, Peng Z, Li X. A Case of a Huge Inferior Vena Cava Leiomyosarcoma: Precise Preoperative Evaluation with Gadobutrol-Enhanced MRI. Cancer Manag Res 2020; 12:7929-7939. [PMID: 32943927 PMCID: PMC7473983 DOI: 10.2147/cmar.s258990] [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: 04/24/2020] [Accepted: 07/24/2020] [Indexed: 01/21/2023] Open
Abstract
Background Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour with poor prognosis. Surgical resection is the first line of treatment to achieve the best possible outcome. However, precise preoperative evaluation is essential to guide therapeutic decisions. Here, the preoperative evaluation potential of gadobutrol-enhanced magnetic resonance imaging (MRI) was assessed in the management of a 42-year-old patient with a large IVC mass. Methods The patient first underwent enhanced computed tomography (CT), but the relationship between the left renal vein and the mass in the dilated IVC was ambiguous, and it remained unclear whether the right hepatic vein was invaded by the lesion. To make a precise assessment of the tumour, the patient subsequently underwent high-resolution MRI angiography examination combined with high-concentration contrast medium gadobutrol. Results MRI demonstrated the integrity of the right hepatic vein and the left renal vein. Following a multidisciplinary consultation, a complicated surgery including complete resection of the mass, artificial vessel replacement of IVC, total hepatectomy, and bilateral nephrectomy with liver and kidney auto-transplantation was performed successfully. The surgical plan formulated after reviewing the MRI preoperatively was adhered to the course of the surgery. Postoperative CT re-examination showed that the blood flow of the artificial blood vessel and the right hepatic vein was unobstructed. Histopathological examination confirmed the tumour to be a leiomyosarcoma. Conclusion Preoperative imaging diagnosis and assessment have important implications for the surgical planning of IVC leiomyosarcoma. High-resolution MRI angiography examination with high concentration contrast medium gadobutrol may be of particular benefit in IVC tumours.
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Affiliation(s)
- Xiaoqi Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Meng Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Shaoqiang Li
- Department of Hepatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Lijian Liang
- Department of Hepatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong, People's Republic of China
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Ryabov AB, Khomyakov VM, Cheremisov VV, Kostrygin AK, Aksenov SA, Pestin IS. [Resection of retroperitoneal leiomyosarcoma followed by replacement of cavarenal segment of inferior vena cava]. Khirurgiia (Mosk) 2020:110-116. [PMID: 32869624 DOI: 10.17116/hirurgia2020081110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors reported a rare clinical case of successful surgical treatment of young female with retroperitoneal leiomyosarcoma followed by lesion of the cavarenal segment of inferior vena cava, left renal vein. Clinical and morphological features of disease, postoperative outcomes and prognostic factors in patients with retroperitoneal leiomyosarcoma are discussed.
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Affiliation(s)
- A B Ryabov
- Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation
| | - V M Khomyakov
- Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation
| | - V V Cheremisov
- Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation
| | - A K Kostrygin
- Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation
| | - S A Aksenov
- Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation
| | - I S Pestin
- Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation
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Grieff AN, Hamilton C, Ady J, Beckerman WE, Shafritz R, Koshenkov V, Rahimi S. Concomitant Aorto-Caval Reconstruction for Inferior Vena Cava Leiomyosarcoma. Ann Vasc Surg 2020; 70:567.e13-567.e17. [PMID: 32795651 DOI: 10.1016/j.avsg.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Leiomyosarcoma of the inferior vena cava (IVC) is a rare smooth muscle neoplasm typically presenting in the fifth to sixth decades of life with both intraluminal and extraluminal growth patterns. Surgical resection remains the gold standard for nonmetastatic disease and often requires vascular reconstruction. We present an atypical case of leiomyosarcoma involving both the IVC and infrarenal abdominal aorta necessitating reconstruction with intraoperative veno-venous bypass. METHODS A 63-year-old man initially presenting with back pain was found to have a large mass adjacent to the IVC on MRI, subsequently confirmed to be leiomyosarcoma by biopsy. After 6 months of neoadjuvant chemotherapy, the patient was taken for resection. However, intraoperatively the tumor was found to involve the aorta necessitating combined aorto-caval reconstruction. To facilitate en-bloc resection of the tumor, the aorta was reconstructed first followed by the inferior vena cava using veno-venous bypass. RESULTS Postoperatively, the patient was taken to the intensive care unit for resuscitation and had an uncomplicated hospital course. He was discharged to rehab 6 days postoperatively and at one year remains free of significant tumor burden with patent aorto-caval bypass grafts. CONCLUSIONS Primary leiomyosarcoma of the IVC is estimated to have aortic involvement in <10% of cases and concurrent aorto-caval reconstruction can be a well-tolerated option in good surgical candidates. Furthermore, veno-venous bypass can be a useful tool for accomplishing successful oncologic resections. With interdisciplinary collaboration between surgical oncologists, urologists, and vascular surgeons, difficult pathologies can be addressed with good patient outcomes.
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Affiliation(s)
- Anthony N Grieff
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Charles Hamilton
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Justin Ady
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William E Beckerman
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Randy Shafritz
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vadim Koshenkov
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Saum Rahimi
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Joung HS, Nooromid MJ, Eskandari MK, Wayne JD. Surgical approach, management, and oncologic outcomes of primary leiomyosarcoma of the inferior vena cava: An institutional case series. J Surg Oncol 2020; 122:1348-1355. [DOI: 10.1002/jso.26163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hae Soo Joung
- Division of Surgical Oncology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Michael J. Nooromid
- Division of Vascular Surgery Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Mark K. Eskandari
- Division of Vascular Surgery Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Jeffrey D. Wayne
- Division of Surgical Oncology Northwestern University Feinberg School of Medicine Chicago Illinois
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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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Buchholz BM, Pinter Carvalheiro da Silva Boteon A, Taniere P, Isaac JR, Gourevitch D, Muiesan P. Autotransplantation of the Liver for Ex Vivo Resection of Intrahepatic Caval Leiomyosarcoma: A Case Report. EXP CLIN TRANSPLANT 2020; 18:396-401. [DOI: 10.6002/ect.2018.0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Inferior vena cava resection and reconstruction with a peritoneal patch for a leiomyosarcoma: A case report. Int J Surg Case Rep 2020; 71:37-40. [PMID: 32438334 PMCID: PMC7235614 DOI: 10.1016/j.ijscr.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 12/17/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava are very rare neoplasm with a limited responsiveness to medical therapy. Surgery seems to be the only chance of cure. Complex vascular resection are often necessary and required accurate reconstruction technique. Peritoneal patch is an efficient and safe option to repair venous defects and it is gaining great attention in recent years.
Introduction Leiomyosarcomas (LMs) of the inferior vena cava (IVC) are very rare neoplasms seldom reported in the literature. The majority of patients does not present with specific abdominal pain and IVC LMs are used to become symptomatic with the increase of tumor volume. The role of chemotherapy or radiotherapy is not yet defined and surgical resection seems to be the only chance to improve survival rates. Presentation of case We present a case of a 58-year-old female with a recent diagnosis of IVC LM who underwent surgery with a partial resection of the anterior wall of the vein using a lateral and partial vein clamping. The primary repair of the defect could result in stricture of the vein, so a parietal peritoneum patch was used for the vein reconstruction. The postoperative course was uneventful. Discussion Actual evidence suggests that vascular sarcomas have limited responsiveness to cytotoxic chemotherapy and chemoradiotherapy, so surgery is the treatment of choice. Major surgery entailing multivisceral and complex vascular resection is usually necessary to achieve negative margins and accurate vascular reconstruction techniques are mandatory to avoid serious circulatory complications. Different kinds of graft (biological or synthetics) are available for the reconstruction, with intrinsic advantages and limitations. The use of peritoneal patches seems a valid and cheap option for vascular reconstruction and it is gaining great attention in recent years. Conclusion This case demonstrates that peritoneal graft could be a safe option to manage IVC defects in expert hands. A brief review of literature is also included.
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Primary iliocaval leiomyosarcomas: The path beyond surgery. Eur J Surg Oncol 2020; 46:893-897. [PMID: 32067874 DOI: 10.1016/j.ejso.2020.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/13/2020] [Accepted: 01/31/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Iliocaval leiomyosarcoma (ICLM) is a rare and aggressive form of sarcoma within the retroperitoneum. Surgery is the mainstay of treatment, with no consensus on the benefit of chemoradiotherapy in the neo/adjuvant setting. This study aims to describe the natural history of a chemotherapy-naïve ICLM treated in a tertiary cancer centre and to explore potential directions to improve oncological outcome. MATERIALS AND METHODS A prospective database was used to identify patient demographics, clinicopathological variables and oncological outcomes in 30 patients who underwent surgical resection in our institution for primary non-metastatic ICLM between 2003 and 2018. RESULTS There was no 90-day mortality. With a median follow-up time of 70.0 months (95% CI 52.6-87.4), 5/30 patients (16.7%) developed local recurrence while 11/30 (36.7%) developed distant metastatic disease. 1 patient (3.3%) developed both local and distant recurrence. Median overall survival of our cohort was 41.0 months (95% CI 33.6-48.4) and 5-year overall survival rate was 32.1%. Multivariate survival analysis using the Cox proportional hazard model identified tumour grade and blood loss of more than 600 mL as key prognostic factors in our model. CONCLUSION Management of ICLM should be centralised in high-volume sarcoma centres with expertise in the management of retroperitoneal sarcomas. Integration of tumour biology with a concerted effort to conduct conclusive multi-centre phase III in histological and molecularly defined sarcoma subgroups is necessary to improve patient outcome. We eagerly await the results of STRASS 2 study to gain more insights to the efficacy of neoadjuvant chemotherapy on patient prognosis.
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Extra Luminal Leiomyosarcoma of Inferior Venacava: a Hepatobiliary Surgeon Perspective. J Gastrointest Cancer 2019; 51:663-666. [PMID: 31828725 DOI: 10.1007/s12029-019-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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