Imaging of leiomyosarcoma of the inferior vena cava: comparison of 2 cases and review of the literature

Abstract

Leiomyosarcoma of the inferior vena cava is a rare tumour arising from the smooth muscle fibres of the media with a mean size at diagnosis generally around 12 cm (range 2-38 cm). This study compares a 4-cm leiomyosarcoma of the inferior vena cava discovered incidentally with a symptomatic late stage leiomyosarcoma.

Figure 1

MR axial images: GRE FLASH T1w fs (A) and TSE T2w (B). GRE VIBE T1w post-Gd in arterial (C) and venous phase (D). The lesion appears homogenous and hypointense (arrow) on T1w fs scan (A) and shows an intermediate signal intensity (arrow) on the T2w sequence (B). An intense, non-homogeneous enhancement in arterial phase (C), with greater filling in venous phase (D) is detected. The IVC appears compressed but well opacified. No plane of cleavage with the duodenal wall is visible.

Figure 2

Leiomyosarcoma with typical intersecting clusters of spindle cells (haematoxylin and eosin stain, magnification×20).

Figure 3

Contrast-enhanced CT axial images in venous phase A large heterogeneously enhanced retroperitoneal mass, arising from the lower IVC, involving more than 50% of the aortic wall and displacing the intestinal loops anteriorly (A) is depicted. The tumour extends to the confluence of the iliac vessels (B). A sagittal multi-planar reconstruction shows a narrowed and irregular IVC for throughout the longitudinal spread of the mass (C).

Figure 4

Leiomyosarcoma composed of elongated cells some with larger and hyperchromatic nuclei (haematoxylin and eosin stain, ×20) (A). Neoplastic cells showed cytoplasmic staining with desmin (immunohistochemistry, ×20) (B).