Leiomyosarcoma of the Abdominal Aorta: A Rare Cause of Renovascular Hypertension

Acute Ischemia of Extremity as a First Manifestation of Peripheral Artery Leiomyosarcoma: Report of a Case and Review of the Literature

Leiomyosarcoma is an aggressive soft tissue sarcoma derived from smooth muscle cells. Of all soft tissue sarcomas, approximately 5-10% are leiomyosarcomas. Vascular leiomyosarcoma constitutes about 2% of all leiomyosarcomas and involves veins 5 times more than arteries. When they arise from a major blood vessel, symptoms of vascular compromise or leg edema may be present. Because they are rare, definite diagnosis is often delayed. We present the case of an 88-year-old man who was admitted to our department with acute limb ischemia stage 4 according to Rutherford's criteria. His personal medical history included arterial hypertension under medication with nonspecific conduction disturbances showed in the electrocardiography. The duplex scan revealed the presence of thrombotic material to the distal superficial femoral and popliteal artery, whereas the presence of popliteal artery aneurysm was excluded. After the initial diagnostic approach, he underwent 2 unsuccessful embolectomy procedures. During the amputation procedure, a 6-cm mass was palpated in the popliteal fossa, and it was excised. The immunohistopathologic study revealed a grade 3 according to the French Federation Nationale des Centers de Lutte Contre le Cancer classification leiomyosarcoma. The patient was discharged 10 days later and referred to an oncologic center. He returned 6 months later with edema of the amputated limb and inguinal lymphadenopathy. Specimen of the inguinal lymph nodes was sent for histopathologic examination, which indicated the recurrence of the disease. Leiomyosarcomas should be taken into consideration in elderly patients presenting with acute limb ischemia.

Aortic Intimal Sarcoma Contributes to Atherosclerotic Renovascular Hypertension: An Autopsy Case Report and Review of the Literature

An autopsy of a 70-year-old man with multiple bone metastases from a malignancy of unknown origin (MUO) and renovascular hypertension revealed an aortic intimal sarcoma (AIS) in the right renal artery accompanied by atherosclerotic changes. AIS appeared as aggregated mutton fat-like translucent particles arising from the intima of the branching portion of the right renal artery and was composed of undifferentiated, fine spindle cells with thicket-like proliferation. AIS was confirmed by immunohistopathology, showing the loss of the lumen lined by CD31-positive endothelium and the expression of CD31, keratin, and vimentin in the viable part of the tumor. In patients with MUO presenting with both bone metastases and an acute or sub-acute onset of renovascular hypertension, AIS in the renal artery may be responsible.

Leiomyosarcoma of the thoracic aorta in a patient with hypertrophic cardiomyopathy

We report a case of leiomyosarcoma of the thoracic aorta in a 49-year-old male patient with history of hypertrophic cardiomyopathy. The only presenting symptom was back pain localized under the left scapula with the frequency and severity of the pain increasing with time. Imaging studies detected the presence of an aortic tumor. The tumor was excised en bloc, and an interposition graft was implanted. The histology showed a fully excised grade 3 leiomyosarcoma. This article discusses features of this rare condition.

Palliative surgery for primary sarcoma in the abdominal aorta: A case report and review of the literature

Primary sarcoma of the aorta is extremely rare and accounts for <1% of all sarcomas. The present study describes the case of a 45-year-old male who presented with lower limb and abdominal pain. Abdominal computed tomography (CT) and magnetic resonance (MR) arteriography revealed a tumor that extended from the infrarenal aorta to the aortic bifurcation. The external and internal iliac arteries were occluded by the tumor incursion. Palliative surgery was performed for the sarcoma since the patient refused a radical resection. To improve the blood supply to the lower limbs, an axillary bifemoral bypass was established. Following the surgery, the pain was significantly reduced. However, the patient succumbed due to extensive metastasis 6 months after this surgery. Aortic sarcoma is an extremely rare disease with a poor prognosis. A diagnosis at a relatively early stage is necessary for a longer survival time. Radical surgery is the most significant treatment. Patients at advanced stages should consider palliative surgery in order to improve their quality of life.

A rare tumor in the adrenal region: neuron-specific enolase (NSE)-producing leiomyosarcoma in an elderly hypertensive patient

A 73-year-old Japanese woman was referred for examination of right flank pain and progressive hypertension. Abdominal CT incidentally detected a right adrenal mass 8 cm in size. The tumor exhibited isodensity by CT and contained high-intense lesion by T2-weighted MRI. Scintigraphy with (131) I-metaiodobenzylguanidine and (131) I-adosterol showed no abnormal uptake by whole body scan. Positron emission tomography scan with (18) F-2-fluoro-D-deoxyglucose demonstrated an exclusive uptake in the right adrenal mass. Adrenocortical hormone levels and catecholamine secretion were within normal range; however, the level of serum neuron-specific enolase (NSE) was found to be markedly high. After controlling systemic blood pressure with an alpha1-blocker, the right adrenal tumor was surgically removed, along with the right kidney and inferior vena cava which adhered to it. The tumor was pathologically proven to be leiomyosarcoma, which was immunohistochemically positive with alpha-smooth muscle actin and negative with CD57, S-100 and c-kit proteins. Notably, NSE protein was massively expressed in the resected tumor. After surgery blood pressure was controlled with regular medication and serum NSE levels have since normalized. The possibility of leiomyosarcoma should be kept in mind in adrenal incidentalomas with rapid growth and atypical radiological images. Our findings suggest that circulating NSE levels may be clinically useful for early detection of recurrence.