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Long L, Zhou L, Ying D, Huang Y, Yang J, Zhou L, Li S, He X, Xie R. Case Report: A case of uterine leiomyosarcoma metastasized to the vena cava, excised with the aid of preoperative CT three-dimensional imaging. Front Oncol 2022; 12:905857. [PMID: 36052267 PMCID: PMC9424754 DOI: 10.3389/fonc.2022.905857] [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: 03/28/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Leiomyosarcoma of the uterus (ULMS) is a rare malignant tumor originating from embryonic mesenchymal cells. ULMS tends to metastasize to the lungs, lymph nodes, liver, and bone. Computed tomography three-dimensional (CT 3D) imaging is an advanced diagnostic technique that can track the vessels and their relationships with tumors and reveal the invasion of vessels, including small vessels, around tumors in any slice. Here, we describe a case in which ULMS extended to the retrohepatic inferior vena cava. To date, no report has described resection of metastatic ULMS of the vena cava through supplemental CT 3D imaging. Our patient presented with right lumbar abdominal pain as the main symptom. After using CT 3D reconstruction to accurately assess the relationship between the tumor and the surrounding organs and blood vessels before the operation, the operation was successfully completed through multidisciplinary surgical collaboration.
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Affiliation(s)
- Ling Long
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
| | - Ling Zhou
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Demei Ying
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
| | - Yan Huang
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
| | - Juan Yang
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
| | - Lu Zhou
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
| | - Sufen Li
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
- *Correspondence: Rongkai Xie, ; Xuan He, ; Sufen Li,
| | - Xuan He
- Cancer Center, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Rongkai Xie, ; Xuan He, ; Sufen Li,
| | - Rongkai Xie
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing, China
- *Correspondence: Rongkai Xie, ; Xuan He, ; Sufen Li,
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Rosenfeld BL, Bashir R, Brisco-Bacik MA, Panidis IP, Vaidya A, Minakata K, Forfia PR. Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921124. [PMID: 32345956 PMCID: PMC7209904 DOI: 10.12659/ajcr.921124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as "thrombus in transit." CASE REPORT The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as "thrombus in transit", this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma. CONCLUSIONS With rare exceptions, "thrombus in transit" is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radiographic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism.
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Affiliation(s)
- Benjamin L Rosenfeld
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Riyaz Bashir
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | | | - Ioannis P Panidis
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Anjali Vaidya
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Kenji Minakata
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Paul R Forfia
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
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Lim YH, Lee LS, Lim CH, Chew GK. Successful removal of uterine leiomyosarcoma tumour thrombus propagating to the right atrium. BMJ Case Rep 2015; 2015:bcr-2015-213384. [PMID: 26607197 DOI: 10.1136/bcr-2015-213384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although intravenous leiomyomatosis is widely documented, intravenous extension of leiomyosarcoma into the inferior vena cava (IVC) and subsequently into the right atrium is extremely rare. Less than five such cases have been reported in the literature worldwide. Uterine leiomyosarcoma is an aggressive smooth muscle tumour occurring with an incidence of 1% in all female genital tract cancers and comprises about 3-7% of uterine cancers. It carries a generally poor prognosis with 5-year survival rates ranging from 18.8% to 65% across all stages. We report a case of primary uterine leiomyosarcoma with intravascular tumour propagation extending to the renal vein, IVC and right atrium of the heart, which was successfully resected in a one stage operation by a multidisciplinary team. This case demonstrates the importance of preoperative radiological staging and multidisciplinary planning.
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Affiliation(s)
- Yu Hui Lim
- Department of Obstetrics and Gynaecology, Singhealth, Singapore, Singapore
| | | | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
| | - Ghee Kheng Chew
- Department of Obstetrics and Gynaecology, Singhealth, Singapore, Singapore
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