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Mitsuo K, Kaneko H, Tsukamoto M, Asami Y, Miyazawa A, Miyashita K, Onoda G, Yamashita H, Hatano M, Kamiyama M, Okuda S. Retroperitoneal leiomyosarcoma mimicking an ovarian tumor diagnosed using a negative ovarian pedicle sign. Radiol Case Rep 2024; 19:3429-3433. [PMID: 38872746 PMCID: PMC11169071 DOI: 10.1016/j.radcr.2024.04.066] [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: 03/04/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 06/15/2024] Open
Abstract
Retroperitoneal leiomyosarcoma (RPLMS) is rare and usually presents as a large abdominal mass with poor clinical symptoms. Radiological findings of an RPLMS arising in the pelvis of a woman resemble those of adnexal tumors. Herein, we present a case of RPLMS mimicking an adnexal tumor which was differentiated from having an ovarian origin as the right ovarian vein was passing through the tumor but there was no direct vascular connection with the tumor. Therefore, it is important to identify the ovarian vein to distinguish between these tumors.
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Affiliation(s)
- Koji Mitsuo
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Hideki Kaneko
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Makoto Tsukamoto
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Yuta Asami
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Azumi Miyazawa
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Keiichi Miyashita
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Go Onoda
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | | | - Mami Hatano
- Department of Pathology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Megumi Kamiyama
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Shigeo Okuda
- Department of Diagnostic Radiology, NHO Tokyo Medical Center, Tokyo, Japan
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2
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Tian Z, Cheng Y, Zhao S, Li R, Zhou J, Sun Q, Wang D. Deep learning radiomics-based prediction model of metachronous distant metastasis following curative resection for retroperitoneal leiomyosarcoma: a bicentric study. Cancer Imaging 2024; 24:52. [PMID: 38627828 PMCID: PMC11020328 DOI: 10.1186/s40644-024-00697-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Combining conventional radiomics models with deep learning features can result in superior performance in predicting the prognosis of patients with tumors; however, this approach has never been evaluated for the prediction of metachronous distant metastasis (MDM) among patients with retroperitoneal leiomyosarcoma (RLS). Thus, the purpose of this study was to develop and validate a preoperative contrast-enhanced computed tomography (CECT)-based deep learning radiomics model for predicting the occurrence of MDM in patients with RLS undergoing complete surgical resection. METHODS A total of 179 patients who had undergone surgery for the treatment of histologically confirmed RLS were retrospectively recruited from two tertiary sarcoma centers. Semantic segmentation features derived from a convolutional neural network deep learning model as well as conventional hand-crafted radiomics features were extracted from preoperative three-phase CECT images to quantify the sarcoma phenotypes. A conventional radiomics signature (RS) and a deep learning radiomics signature (DLRS) that incorporated hand-crafted radiomics and deep learning features were developed to predict the risk of MDM. Additionally, a deep learning radiomics nomogram (DLRN) was established to evaluate the incremental prognostic significance of the DLRS in combination with clinico-radiological predictors. RESULTS The comparison of the area under the curve (AUC) values in the external validation set, as determined by the DeLong test, demonstrated that the integrated DLRN, DLRS, and RS models all exhibited superior predictive performance compared with that of the clinical model (AUC 0.786 [95% confidence interval 0.649-0.923] vs. 0.822 [0.692-0.952] vs. 0.733 [0.573-0.892] vs. 0.511 [0.359-0.662]; both P < 0.05). The decision curve analyses graphically indicated that utilizing the DLRN for risk stratification provided greater net benefits than those achieved using the DLRS, RS and clinical models. Good alignment with the calibration curve indicated that the DLRN also exhibited good performance. CONCLUSIONS The novel CECT-based DLRN developed in this study demonstrated promising performance in the preoperative prediction of the risk of MDM following curative resection in patients with RLS. The DLRN, which outperformed the other three models, could provide valuable information for predicting surgical efficacy and tailoring individualized treatment plans in this patient population. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Zhen Tian
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yifan Cheng
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Shuai Zhao
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ruiqi Li
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jiajie Zhou
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Qiannan Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Cholankeril TJ, Lou J, Spitz F, Tjaden B. Resection of primary left renal vein leiomyosarcoma with renal preservation following an unusual clinical presentation. BMJ Case Rep 2024; 17:e254856. [PMID: 38499354 PMCID: PMC10952917 DOI: 10.1136/bcr-2023-254856] [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] [Indexed: 03/20/2024] Open
Abstract
An elderly man was referred to vascular surgery on incidental discovery of a left retroperitoneal mass ultimately found to be of left renal vein (LRV) origin. He initially presented with recurring lower back pain. CT of the abdomen/pelvis showed a 6.0×5.5 cm lobulated retroperitoneal mass anterior to the infrarenal aorta. Resection of the mass necessitated a multidisciplinary team consisting of medical oncologists, radiation oncologists, urologists and vascular surgeons. In efforts to obtain an R0 margin, en-bloc resection of the LRV from its confluence with the inferior vena cava (IVC) was necessary. A primary repair of the IVC was performed with preservation of the left kidney. The patient's back pain has since resolved after the surgery. A literature search found IVC reconstructions to be safe and effective in the removal of vascular leiomyosarcomas.
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Affiliation(s)
| | - Johanna Lou
- Cooper University Health Care, Camden, New Jersey, USA
| | - Francis Spitz
- Cooper University Health Care, Camden, New Jersey, USA
| | - Bruce Tjaden
- Cooper University Health Care, Camden, New Jersey, USA
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Zheng J, Zhuang A, Xia X, Miao F, Wang Z, Kong X, Ren Y, Ma Y, Lin Z, Lu W, Li W. Nomogram development and external validation for predicting overall survival and cancer-specific survival in patients with primary retroperitoneal sarcoma: a retrospective cohort study. Discov Oncol 2023; 14:197. [PMID: 37910291 PMCID: PMC10620366 DOI: 10.1007/s12672-023-00804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Primary retroperitoneal sarcoma (RPS) comprises over 70 histologic subtypes, yet there are limited studies that have developed prognostic nomograms for RPS patients to predict overall survival (OS) and cancer-specific survival (CSS). The objective of this study was to construct prognostic nomograms for predicting OS and CSS in RPS patients. METHODS We identified a total of 1166 RPS patients from the Surveillance, Epidemiology and End Results (SEER) database, and an additional 261 cases were collected from a tertiary cancer center. The study incorporated various clinicopathological and epidemiologic features as variables, and prediction windows for overall survival (OS) and cancer-specific survival (CSS) were set at 3, 5, and 7 years. Multivariable Cox models were utilized to develop the nomograms, and variable selection was performed using a backward procedure based on the Akaike Information Criterion. To evaluate the performance of the nomograms in terms of calibration and discrimination, we used calibration plots, coherence index, and area under the curve. FINDINGS The study included 818 patients in the development cohort, 348 patients in the internal validation cohort, and 261 patients in the external validation cohort. The backward procedure selected the following variables: age, French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade, pre-/postoperative chemotherapy, tumor size, primary site surgery, and tumor multifocality. The validation results demonstrated that the nomograms had good calibration and discrimination, with C-indices of 0.76 for OS and 0.81 for CSS. Calibration plots also showed good consistency between the predicted and actual survival rates. Furthermore, the areas under the time-dependent receiver operating characteristic curves for the 3-, 5-, and 7-year OS (0.84, 0.82, and 0.78, respectively) and CSS (0.88, 0.88, and 0.85, respectively) confirmed the accuracy of the nomograms. INTERPRETATION Our study developed accurate nomograms to predict OS and CSS in patients with RPS. These nomograms have important clinical implications and can assist healthcare providers in making informed decisions regarding patient care and treatment options. They may also aid in patient counseling and stratification in clinical trials.
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Affiliation(s)
- Jialiang Zheng
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Aobo Zhuang
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xiaogang Xia
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Fenglin Miao
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zhao Wang
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xu Kong
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yantao Ren
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yuan Ma
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zhenhang Lin
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200000, China.
| | - Wengang Li
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China.
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China.
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Feng Z, Li Y. Web-based nomograms for predicting overall survival and cancer-specific survival in retroperitoneal leiomyosarcoma: a population-based analysis. J Cancer Res Clin Oncol 2023; 149:11735-11748. [PMID: 37405479 DOI: 10.1007/s00432-023-05052-y] [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: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Retroperitoneal leiomyosarcoma is a type of carcinoma with low incidence and poor prognosis, and prognostic factors are currently unknown. Therefore, our study aimed to investigate the predictive factors of RPLMS and establish prognostic nomograms. METHODS Patients diagnosed with RPLMS between 2004 and 2017 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors were identified by univariate and multivariate COX regression analyses and used to generate nomograms to predict overall survival (OS) and cancer-specific survival (CSS). RESULTS 646 eligible patients were randomly divided into training set (n = 323) and validation set (n = 323). Multivariate COX regression analysis indicated that the independent risk factors for OS and CSS were age, tumor size, grade, SEER stage, and surgery. In the nomogram of OS, the concordance indices (C-index) of the training and validation sets were 0.72 and 0.691, and in the nomogram of CSS, the C-indices of the training and validation sets were 0.737 and 0.737. Furthermore, calibration plots showed that the predicted results of the nomograms in the training and validation sets agree well with the actual observations. CONCLUSION Age, tumor size, grade, SEER stage, and surgery were independent prognostic factors for RPLMS. The nomograms developed and validated in this study can accurately predict the OS and CSS of patients, which could help clinicians make individualized survival predictions. Finally, we make the two nomograms into two web calculators for the convenience of clinicians.
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Affiliation(s)
- Zhile Feng
- General Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People's Republic of China
| | - Yongxiang Li
- General Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People's Republic of China.
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Janes LA, Angeles CV. The Role of Surgery in Oligometastatic Retroperitoneal Sarcoma. Curr Oncol 2023; 30:5240-5250. [PMID: 37366881 DOI: 10.3390/curroncol30060398] [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: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Retroperitoneal sarcomas are extremely rare, comprising <15% of primary sarcomas. Distant metastasis occurs in about 20% of cases, with pulmonary and hepatic metastasis as the most common sites of hematogenous spread. Although surgical resection is well established as the main treatment of localized primary disease, there are limited guidelines for the surgical treatment of intra-abdominal and distant metastases. There are inadequate systemic treatment options for patients with metastatic sarcoma, thereby necessitating the consideration of surgical options in carefully selected patients. Key points to consider include tumor biology, patient fitness and co-morbidities, overall prognosis, and goals of care. Multidisciplinary sarcoma tumor board discussion for each case is an essential practice in order to deliver the best care to these patients. The purpose of this review is to summarize the published literature on the past and present role of surgery in the treatment of oligometastatic retroperitoneal sarcoma in order to inform the management of this difficult disease.
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Affiliation(s)
- Lindsay A Janes
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Christina V Angeles
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Drive, 6219 Cancer Center Ann Arbor, Ann Arbor, MI 48109, USA
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7
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De Biasi G, Cazzato G, Colagrande A, Maiorano E, Ingravallo G. Giant Soft Tissue Leiomyosarcoma of the Left Lower Extremity: Case Presentation With a Review of the Literature. Cureus 2023; 15:e37058. [PMID: 37153250 PMCID: PMC10155594 DOI: 10.7759/cureus.37058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
Leiomyosarcoma (LMS) accounts for approximately 5-10% of soft tissue sarcomas, with an estimated incidence in the United States (US) of less than one case/200,000 persons, more frequent in women than men. Approximately two-thirds of LMSs are retroperitoneal, abdominal, and mediastinal. Localized, soft tissue LMSs represent a lower percentage, with the lower limbs and trunk being the most frequently involved sites. LMSs larger than 5 cm (so-called giants) are even rarer, and to date have been little reported in the literature. In this paper, we present the case of a giant LMS of the left lower limb in a 73-year-old patient, who had a mass for about two years, and who, after the first diagnostic biopsy, underwent limb amputation. Macroscopic and microscopic examinations confirmed the infiltration of the underlying tibial bone. We briefly discuss eight other cases described in the literature with similar size, pointing out that the parameters with the greatest impact on prognosis proved to be size >5 cm and depth of invasion. Due to the rarity of this neoplasm, little has yet been done in relation to the most suitable therapeutic treatment of such patients, and larger case series are mandated in order to be able to conduct broader-spectrum studies.
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Hajji F, Azami MA, Adlouni S, Benazzouz A, Ghoundale O. Primary Leiomyosarcoma of the Ovarian Vein Causing Obstructive Uropathy: A Case Report. Cureus 2022; 14:e28510. [PMID: 36059294 PMCID: PMC9420559 DOI: 10.7759/cureus.28510] [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] [Accepted: 08/28/2022] [Indexed: 11/06/2022] Open
Abstract
Retroperitoneal vascular leiomyosarcoma (RVLMS) are rare soft-tissue sarcomas that most commonly arise from large blood vessels and have a poor prognosis. We present the case of a 61-year-old woman who presented with isolated left flank pain. Abdominal computed tomography and magnetic resonance imaging revealed a 5 cm retroperitoneal soft-tissue mass that was contiguous with the left ovarian vein and connected to the proximal ureter, causing hydronephrosis. As ureteroscopy suggested extrinsic compression of the ureter, a percutaneous biopsy of the mass was obtained, whereupon diagnosis of leiomyosarcoma was made. Radical en-bloc excision of the tumor, including the involved upper urinary tract and the gonadal vein, was performed. The tumor proved to be a leiomyosarcoma arising from the ovarian vein wall. No adjuvant therapy was planned, and no recurrence was noticed at her 24-month follow-up. Primary RVLMS of the ovarian vein is an uncommon condition. To date, only a few sporadic cases have been reported in the literature. What makes the present case further interesting is the unusual tumor’s relationship with the patient’s ureter, raising both diagnostic and management challenges. To our best knowledge, this is so far the fourth reported case of its kind to cause ureteral obstruction.
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9
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Yokoyama Y, Goda T, Sato K, Suzuki M, Kanda T, Sato Y. Leiomyosarcoma arising from the ovarian vein as a gynecologic malignancy: Two case reports and a review of the literature. J Obstet Gynaecol Res 2022; 48:2224-2230. [PMID: 35793911 DOI: 10.1111/jog.15242] [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: 11/17/2021] [Revised: 03/06/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
Leiomyosarcoma arising from the ovarian vein has rarely been reported. Herein, we report two cases from a single institute. Given their direct connections to ovarian vessels, both leiomyosarcomas were initially suspected to be gynecological malignancies. In one case, leiomyosarcoma was discovered incidentally without any clinical symptoms; it had a close connection with the ovarian vein, was removed surgically, and the patient has survived for over 12 years. In another case, bowel obstruction caused by the tumor helped to identify metastatic leiomyosarcoma. Blood flow was supplied by the ovarian artery and grew into the lumen of the ovarian vein without invading adjacent organs. After surgical resection, the patient underwent 18 months of chemotherapy prior to palliative care. We propose that leiomyosarcoma arising from the ovarian vein should be treated as a gynecologic malignancy, especially if it develops in the lower abdomen.
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Affiliation(s)
- Yasuhiro Yokoyama
- Department of Gynecology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Tomohiro Goda
- Department of Gynecology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kazuki Sato
- Department of Gynecology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Mariko Suzuki
- Department of Gynecology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Tomoko Kanda
- Department of Gynecology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yasumasa Sato
- Department of Gynecology, Gifu Prefectural General Medical Center, Gifu, Japan
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Bello HR, Sekhar A, Filice RW, Radmard AR, Davarpanah AH. Pancreaticoduodenal Groove: Spectrum of Disease and Imaging Features. Radiographics 2022; 42:1062-1080. [PMID: 35594198 DOI: 10.1148/rg.210168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pancreaticoduodenal groove (PDG) is a small space between the pancreatic head and duodenum where vital interactions between multiple organs and physiologic processes take place. Muscles, nerves, and hormones perform a coordinated dance, allowing bile and pancreatic enzymes to aid in digestion and absorption of critical nutrition. Given the multitude of organs and cells working together, a variety of benign and malignant entities can arise in or adjacent to this space. Management of lesions in this region is also complex and can involve observation, endoscopic resection, or challenging surgeries such as the Whipple procedure. The radiologist plays an important role in evaluation of abnormalities involving the PDG. While CT is usually the first-line examination for evaluation of this complex region, MRI offers complementary information. Although features of abnormalities involving the PDG can often overlap, understanding the characteristic imaging and pathologic features generally allows categorization of disease entities based on the suspected organ of origin and the presence of ancillary features. The goal of the authors is to provide radiologists with a conceptual approach to entities implicating the PDG to increase the accuracy of diagnosis and assist in appropriate management or presurgical planning. They briefly discuss the anatomy of the PDG, followed by a more in-depth presentation of the features of disease categories. A table summarizing the entities that occur in this region by underlying cause and anatomic location is provided. ©RSNA, 2022.
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Affiliation(s)
- Hernan R Bello
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Aarti Sekhar
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Ross W Filice
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Amir Reza Radmard
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
| | - Amir H Davarpanah
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1365-A Clifton Rd NE, Suite AT-627, Atlanta, GA 30322 (H.R.B., A.S., A.H.D.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.W.F.); and Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (A.R.R.)
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11
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Wang MX, Dillman JR, Guccione J, Habiba A, Maher M, Kamel S, Panse PM, Jensen CT, Elsayes KM. Neurofibromatosis from Head to Toe: What the Radiologist Needs to Know. Radiographics 2022; 42:1123-1144. [PMID: 35749292 DOI: 10.1148/rg.210235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) are autosomal dominant inherited neurocutaneous disorders or phakomatoses secondary to mutations in the NF1 and NF2 tumor suppressor genes, respectively. Although they share a common name, NF1 and NF2 are distinct disorders with a wide range of multisystem manifestations that include benign and malignant tumors. Imaging plays an essential role in diagnosis, surveillance, and management of individuals with NF1 and NF2. Therefore, it is crucial for radiologists to be familiar with the imaging features of NF1 and NF2 to allow prompt diagnosis and appropriate management. Key manifestations of NF1 include café-au-lait macules, axillary or inguinal freckling, neurofibromas or plexiform neurofibromas, optic pathway gliomas, Lisch nodules, and osseous lesions such as sphenoid dysplasia, all of which are considered diagnostic features of NF1. Other manifestations include focal areas of signal intensity in the brain, low-grade gliomas, interstitial lung disease, various abdominopelvic neoplasms, scoliosis, and vascular dysplasia. The various NF1-associated abdominopelvic neoplasms can be categorized by their cellular origin: neurogenic neoplasms, interstitial cells of Cajal neoplasms, neuroendocrine neoplasms, and embryonal neoplasms. Malignant peripheral nerve sheath tumors and intracranial tumors are the leading contributors to mortality in NF1. Classic manifestations of NF2 include schwannomas, meningiomas, and ependymomas. However, NF2 may have shared cutaneous manifestations with NF1. Lifelong multidisciplinary management is critical for patients with either disease. The authors highlight the genetics and molecular pathogenesis, clinical and pathologic features, imaging manifestations, and multidisciplinary management and surveillance of NF1 and NF2. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Mindy X Wang
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Jonathan R Dillman
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Jeffrey Guccione
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Ahmed Habiba
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Marwa Maher
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Serageldin Kamel
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Prasad M Panse
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Corey T Jensen
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Khaled M Elsayes
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
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12
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Ramakrishnan K, Levy N, Goldbach A, Nagarathinam R, Ali S, Ling S, Jonnalagadda P. Imaging of Soft tissue sarcomas of the extremities with Radiologic-Pathologic Correlation. Curr Probl Diagn Radiol 2022; 51:868-877. [DOI: 10.1067/j.cpradiol.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022]
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13
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Alsaghyir AA, Alhajress GI, Aldraihem K, Alhaidar A, Nazer AI. Leiomyosarcoma Invading the Vena Cava: A Case Report. Cureus 2022; 14:e22838. [PMID: 35399419 PMCID: PMC8980250 DOI: 10.7759/cureus.22838] [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] [Accepted: 03/04/2022] [Indexed: 11/05/2022] Open
Abstract
Leiomyosarcoma is an aggressive soft tissue tumor originating from smooth muscle cells typically of the uterus, gastrointestinal, or genitourinary system. The most common site of leiomyosarcoma of soft tissue is the retroperitoneum, accounting for 50% of all cases. The majority of patients are asymptomatic, which may be due to the large retroperitoneal cavity. However, when symptoms do occur, they are vague in nature. The most common growth pattern is an entirely extravascular mass. We are presenting an interesting case of a 65-year-old lady, who was referred to our hospital as a case of large left retroperitoneal mass with left renal vein thrombosis. She was biopsied and diagnosed with leiomyosarcoma with invasion into descending colon and the left renal vein, which led to renal vein thrombus. In the last few decades, there is a lack of studies about leiomyosarcoma invading the renal vein and Inferior Vena Cava (IVC). As far as we know, the leiomyosarcoma of a major blood vessel is extremely rare. Since leiomyosarcoma often has a late presentation with the advanced stage when detected, a high index of suspicion is needed to be detected early and avoid such a complication.
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14
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Kim MY, Lee JK, Mietelka KA, Han HJ. Case Report: Giant Multiloculated Pseudocystic Jejunal Leiomyosarcoma in a Dog: Atypical Morphologic Features of Canine Intestinal Leiomyosarcoma. Front Vet Sci 2022; 9:791133. [PMID: 35211538 PMCID: PMC8861198 DOI: 10.3389/fvets.2022.791133] [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: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022] Open
Abstract
A 10-year-old intact female Rottweiler dog weighing 29 kg presented with 2 days history of vomiting, anorexia, and lethargy to KonKuk University Teaching Hospital, Seoul, South Korea. Ultrasonography and computed tomography (CT) scannings revealed a well-demarcated, large mass (29 × 19 × 11 cm) with numerous fluid-filled cavities. Metastases to adjacent lymph nodes were also identified on CT. This large mass and the affected intestinal segments were excised for palliative purposes. Postoperatively, the dog recovered uneventfully without any complications. The cut surface of the mass showed an exophytic growth pattern of multiloculated cystic lesions filled with serosanguineous fluid, large cavities filled with necrotic exudate, and fistulous connections between the intestinal lumen and the necrotic cavity in the mass. On histopathology, the mass was a spindle cell neoplasm expanding from the jejunal muscular layer and with pseudocystic changes. Additional immunohistochemical analysis using antibodies against smooth muscle actin, desmin, and CD-117 demonstrated that the mass was consistent with a leiomyosarcoma. Six months post-operatively, plain radiography revealed an abdominal mass, suspected to be recurrence from jejunal leiomyosarcoma. The owner decided to euthanize the dog due to financial constraints. This case report describes the atypical morphology and clinical progression of a large canine jejunal leiomyosarcoma, which had similar clinical features as those of human leiomyoma and leiomyosarcoma.
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Affiliation(s)
- Mu-Young Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | | | | | - Hyun-Jung Han
- Department of Veterinary Emergency and Critical Care Medcine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul, South Korea
- *Correspondence: Hyun-Jung Han
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15
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Zhang HX, Wang K, Hong P, Lu M, Liu Z, Liu L, Wang GL, Ma LL. Clinical experience with the treatment of retroperitoneal vascular leiomyosarcoma originating from large veins. BMC Surg 2021; 21:326. [PMID: 34392834 PMCID: PMC8364698 DOI: 10.1186/s12893-021-01322-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retroperitoneal vascular leiomyosarcoma (RVLMS) is an extremely rare disease in clinical practice, and it has poor prognosis. This article is to explore the diagnosis and treatment of RVLMS and present our experience. METHODS Data of RVLMS patients were continuously collected in our hospital from August 2018 to February 2020: two males and two females with a median age of 56 (min-max = 33-61) years were included. Patients in whom paraganglioma could not be excluded were asked to take phenoxybenzamine before surgery. A multi-disciplinary team (MDT) meeting had been held and surgery was recommended. The operation procedures varied based on the tumor location, shape, and stage, and the core steps were "exposure of the retroperitoneum and tumor, identification of vital blood vessels, blocking the bloodstream, complete removal of the tumor and tumor thrombus, and release of blood flow". A Satinsky clamp was used to partially block the blood vessels. Follow-up was conveyed by revisits and phone calls. RESULTS One patient underwent open surgery, and three patients underwent laparoscopic surgery, one of whom underwent conversion to open surgery. The procedures were finished successfully, with a median operative time of 314.5 (min-max = 224-467) mins. The median amount of intraoperative bleeding was 550 (min-max = 200-1500) ml, and three patients had transfusion during the operation. The mass was irregular in shape, with a median maximum size of 7.45 (min-max = 4.2-10.7) cm, and the pathological examination confirmed RVLMS, which has spindle-shape, high mitotic activity and atypia. One week after the operation, the median serum creatinine level was 85 (min-max = 70-99) µmol/L. The median follow-up time was 16 (min-max = 13-21) months, and 1 case reported asymptomatic recurrence. CONCLUSION Uncharacteristic manifestations and imaging features contribute to the problematic diagnosis of RVLMS. Comprehensive preoperative evaluation and careful surgical planning are essential. Multicenter research is needed in the future to reach a dominant consensus.
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Affiliation(s)
- Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Kai Wang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China.
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China.
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16
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Al-Dasuqi K, Irshaid L, Mathur M. Radiologic-Pathologic Correlation of Primary Retroperitoneal Neoplasms. Radiographics 2021; 40:1631-1657. [PMID: 33001785 DOI: 10.1148/rg.2020200015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An earlier incorrect version of this article appeared in print. The online version is correct.
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Affiliation(s)
- Khalid Al-Dasuqi
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Lina Irshaid
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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17
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Takagi T, Saito S, Yokota S, Kaneko Y, Takahashi K, Kanamaru R, Kurashina K, Hosoya Y, Kitayama J, Kawata H, Osawa H, Sata N. Laparoscopic and endoscopic cooperative surgery for leiomyosarcoma of the stomach: a case report with a review of the literature. Surg Case Rep 2021; 7:146. [PMID: 34143361 PMCID: PMC8212316 DOI: 10.1186/s40792-021-01218-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background Leiomyosarcoma is a rare tumor that could originate from the gastrointestinal tract, uterus, kidney, retroperitoneum, and the soft tissues of the extremities. It accounts for only 1% of all gastrointestinal mesenchymal tumors and primary leiomyosarcoma of the stomach is extremely rare. Most cases reported as leiomyosarcoma of the stomach before the development of KIT immunohistochemistry might be gastrointestinal stromal tumors (GISTs) of the stomach and only 18 cases of leiomyosarcoma of the stomach have been reported since early 2000s. We report here a patient with leiomyosarcoma of the stomach treated by laparoscopic and endoscopic cooperative surgery (LECS). Case presentation A 59-year-old man was referred to our hospital for an early gastric cancer, which was initially treated by endoscopic submucosal dissection. Six months after his initial treatment, a follow-up esophagogastroduodenoscopy revealed a small polypoid lesion at the lesser curvature of the proximal stomach, which appeared to be a hyperplastic polyp. However, one and a half years later, the lesion grew and showed more irregular surface. Biopsy at the time revealed smooth muscle cell proliferation suggestive of leiomyoma. Three years later, the lesion grew even larger and biopsy showed pleomorphic spindle cells. Immunohistochemical study showed positive staining for alpha-smooth muscle actin and desmin, but negative for c-kit and CD34. Ki-67 labeling index was nearly 60%. Based on these findings, the diagnosis of leiomyosarcoma was established. The patient subsequently underwent a partial gastrectomy by LECS. The patient is currently in good condition without recurrence or metastasis at 12 months after surgery. Conclusions Leiomyosarcoma of the stomach is extremely rare. This is the first report of leiomyosarcoma of the stomach treated by LECS. We could also follow its appearance change through endoscopic examination for 3 years.
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Affiliation(s)
- Toru Takagi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shin Saito
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Shinichiro Yokota
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 1521, USA
| | - Yuki Kaneko
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazuya Takahashi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Rihito Kanamaru
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kentaro Kurashina
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoshinori Hosoya
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Joji Kitayama
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hirotoshi Kawata
- Department of Pathology, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Osawa
- Department of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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18
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Koyama R, Maeda Y, Minagawa N, Shinohara T. A case of laparoscopic resection of leiomyosarcoma arising in the mesentery of descending colon: a case report and review of the literature. Clin Case Rep 2020; 8:3344-3348. [PMID: 33363931 PMCID: PMC7752332 DOI: 10.1002/ccr3.3174] [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: 05/24/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 11/12/2022] Open
Abstract
Leiomyosarcoma of mesenteric origin is rare and may be managed by laparoscopic surgery as a less invasive procedure, on the condition that the tumor can be resected with a safe margin.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
| | - Yoshiaki Maeda
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
| | - Nozomi Minagawa
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
| | - Toshiki Shinohara
- Department of Gastrointestinal SurgeryHokkaido Cancer CenterSapporoJapan
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19
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Xu Y, Xie W, Shang D. Primary leiomyosarcoma is a rare cause of femoral triangle mass: A case report. Vascular 2020; 29:468-471. [PMID: 33054681 DOI: 10.1177/1708538120957478] [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 Primary leiomyosarcoma in the femoral vein is an extremely rare vascular disorder and is often misdiagnosed. In order to improve the knowledge and treatment of this disease, a case of leiomyosarcoma in the femoral vein was reported. METHODS We report the case of a 58-year-old woman with a leiomyosarcoma of the femoral vein and treated successfully by surgical resection. After surgery, no recurrence had been noted follow-up.Subsequently, we reviewed information derived from 31 previously published cases from 1954 to 2019. RESULTS A total of 31 patients diagnosed with femoral vein leiomyosarcoma were presented in previous studies; in all of these patients, 14 (45.2%, 14/31) patients were men. Of these, the median age was 51.6 years old (ranging from 3 to 84). CONCLUSIONS Complete resection with adjuvant chemotherapeutic was the main strategy to treat the disease. Prognosis remains poor if metastasis was present, especially pulmonary metastasis.
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Affiliation(s)
- Yingjiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, China.,Key Laboratory of Metabolism and Molecular Medicine, The Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai, China
| | - Weiping Xie
- Department of Rehabilitation Medicine, People's Hospital of Dingtao District, Heze City, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Wang Y, Teng Y, Na S, Yuan Y. Pleomorphic Leiomyosarcoma of the Adrenal Gland in a Young Woman: A Case Report and Review of the Literature. Onco Targets Ther 2020; 13:4705-4713. [PMID: 32547099 PMCID: PMC7263850 DOI: 10.2147/ott.s254162] [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: 03/16/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022] Open
Abstract
Leiomyosarcoma usually arises in the uterus, abdominal and urologic viscera, and walls of large and small blood vessels. However, primary adrenal leiomyosarcoma is extremely rare with only 39 cases previously reported in English-language literature. We report a case of a 29-year-old previously healthy woman with an incidentally found right adrenal-occupying lesion. CT scan revealed a right adrenal mass measuring 3.3×3.4 cm in size. The tumor was successfully removed by laparoscopic adrenalectomy. Postoperative histopathologic examination showed spindle cells arranged in interlacing fascicles with pleomorphism and a high mitotic rate. An immunohistochemical examination showed positive staining for SMA, desmin, vimentin and H-caldesmon, and the diagnosis of a well-differentiated adrenal leiomyosarcoma was established. The patient received no other oncological treatment after surgery and currently has no evidence of residual disease or tumor recurrence according to imaging follow-up.
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Affiliation(s)
- Yuanyuan Wang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yongliang Teng
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Shibo Na
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Ye Yuan
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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21
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Karaosmanoglu AD, Onur MR, Uysal A, Akata D, Ozmen MN, Karcaaltincaba M. Tumor in the veins: an abdominal perspective with an emphasis on CT and MR imaging. Insights Imaging 2020; 11:52. [PMID: 32215762 PMCID: PMC7096619 DOI: 10.1186/s13244-020-00854-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
Endovenous tumor thrombus in abdomen should be accurately diagnosed as it is a significant finding that may change medical and surgical treatment approaches. As some underlying reasons for endovenous tumor thrombi are relatively rare and imaging findings may be quite subtle, they can be easily overlooked which may have important clinical consequences. In this paper, we described the various imaging aspects of endovenous tumor thrombi originating from various tumor types in different venous structures of the abdomen.
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Affiliation(s)
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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22
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Bajaj G, Tirumani H, Whisman MK, Raichandani S, Ram R, Jambhekar K, Gardner JM, Pandey T. Comprehensive Review of Abdominopelvic Mesenchymal Tumors with Radiologic Pathologic Correlation and Update on Current Treatment Guidelines - Part 1. Semin Ultrasound CT MR 2020; 41:222-238. [PMID: 32446433 DOI: 10.1053/j.sult.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies accounting for only 1% of all solid adult malignancies. These have been categorized in 12 broad groups by the World Health Organization (WHO) with their recent update in 2013. Majority of them lack specific imaging features serving as imaging conundrums for a radiologist. These are often large masses at presentation as they are asymptomatic or cause vague clinical symptoms. These tumors are challenging for surgeons as well as they find it difficult to achieve complete resection because of complex intra-abdominal anatomy and their close relationship with critical structures. Often, a multidisciplinary approach is required to decide on the most appropriate management for these complex cases so as to provide optimal patient care. Knowledge of the WHO classification, pathologic features and available treatment options will help the radiologist make a meaningful contribution in multidisciplinary discussions of such cases and overall patient care. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor are the 3 most common primary intra-abdominal sarcomas. In part 1 of this article, general features of soft tissue sarcomas and some of the common tumors from WHO category 1-4 found in abdomen and pelvis are discussed. Part 2 will focus on common tumors from remainder of the WHO categories.
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Affiliation(s)
- Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Harika Tirumani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michella K Whisman
- Department of Pathology and Clinical Laboratories, University of Michigan, Ann Arbor, MI
| | - Surbhi Raichandani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kedar Jambhekar
- Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jerad M Gardner
- Department of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR
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23
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Two-stage combined treatment of leiomyosarcoma of iliac vein using robotic surgery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:586-588. [PMID: 31799486 PMCID: PMC6881626 DOI: 10.1016/j.jvscit.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
Abstract
Vascular leiomyosarcoma is a rare tumor originating from the vascular smooth muscle cells. Leiomyosarcomas of the external iliac vein are extremely rare. Only single observations of this tumor are reported. We describe a 48-year-old woman who underwent a two-step combined treatment: robot-assisted removal of the extraperitoneal tumor and removal of the lower part of the tumor from the open femoral approach. There have been no signs of tumor recurrence during the 34-month follow-up period.
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Intravascular Leiomyosarcoma in the Left Renal Vein. J Belg Soc Radiol 2019; 103:56. [PMID: 31646267 PMCID: PMC6777199 DOI: 10.5334/jbsr.1911] [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] [Indexed: 12/03/2022] Open
Abstract
Main teaching point: The typical imaging feature of intravascular leiomyosarcoma is a heterogeneous enhancing mass within an expanded vessel.
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Sephien A, Mousa MS, Bui MM, Kedar R, Thomas K. Leiomyosarcoma of the Inferior Vena Cava with Hepatic and Pulmonary Metastases: Case Report. J Radiol Case Rep 2019; 13:30-40. [PMID: 31558957 DOI: 10.3941/jrcr.v13i5.3641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Sarcomas are connective tissue tumors accounting for only 1% of all adult malignancies. Leiomyosarcoma (LMS) is a sarcoma arising from smooth muscle cells, and accounts for 10-20% of all sarcomas. A subtype of LMS are those originating from the smooth muscle of blood vessels. Leiomyosarcoma of the inferior vena cava is a sarcomatous tumor, with less than 350 cases described in the literature. It carries a poor prognosis, with 5- and 10-year survival rates of 31.4% and 7.4%, respectively. We present a case of a 46-year-old female with no significant past medical history presented to the emergency department with mild abdominal pain and distention, early satiety, and weight loss for three weeks, found to have unresectable metastatic leiomyosarcoma of the inferior vena cava.
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Affiliation(s)
- Andrew Sephien
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mina S Mousa
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Marilyn M Bui
- Department of Pathology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Rajendra Kedar
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kerry Thomas
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
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