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Case Reports
. 2022;29(2):258-270.
doi: 10.15388/Amed.2022.29.2.12. Epub 2022 Jun 29.

Incidentally Diagnosed Extraluminal Leiomyosarcoma of Infrarenal Inferior Vena Cava: A Case Report and Literature Review from a Radiologist's Perspective

A Ebinesh  1 , Aanchal Ashta  2 , Satyam  1 , Gaurav Shanker Pradhan  1 , Rohin Sharma  1 , Prince Das  3
Affiliations
Case Reports

Incidentally Diagnosed Extraluminal Leiomyosarcoma of Infrarenal Inferior Vena Cava: A Case Report and Literature Review from a Radiologist's Perspective

A Ebinesh et al. Acta Med Litu. 2022.

Abstract
in English, Lithuanian

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.

Įvadas: Kraujagyslių lejomiosarkoma yra retas, tačiau dažniausiai pasitaikantis apatinės tuščiosios venos navikas.

Atvejo aprašymas: 62 metų pacientui, kuris kreipėsi į gydymo įstaigą dėl pilvo srities skausmo po neaštriu daiktu sukeltos traumos, buvo atsitiktinai nustatyta neluminalinės infrarenalinės apatinės tuščiosios venos lejomiosarkoma.Ultragarso tyrimas atskleidė skiltinį hipoechogenišką pažeidimą viršutinėje pilvo srityje. Kompiuterinė tomografija (KT) ir magnetinio rezonanso tomografija (MRT) parodė, kad priešakinėje infrarenalinėje apatinėje tuščiojoje venoje yra apibrėžtas skiltinis, beveik homogeniškai intensyvėjantis retroperitoninis pažeidimas, kuris didžiausio sąlyčio vietoje su tuščiosios venos spindžiu į dešinę nuo centro yra beveik nematomas. Pozitronų emisijos tomografijos (PET) metu pažeidimas parodė nedidelį fluorodeoksigliukozės (FDG) įsisavinimą be jokių tolimų metastazių. Atlikus kompiuterine tomografija paremta biopsiją su imunohistochemine analize, nustatyta lejomiosarkoma. Pacientui buvo atlikta chirurginė rezekcija ir apatinės tuščiosios venos rekonstrukcija.

Išvados: Apatinės tuščiosios venos lejomiosarkoma yra retas kraujagyslių sistemos auglys. Diagnozei ir vertinimui iki operacijos būtina peržiūrėti vaizdinę medžiagą. Šiame straipsnyje taip pat pateikiama išsami literatūros apžvalga apie radiologines apatinės tuščiosios venos lejomiosarkomos savybes, kurios pagerintų optimalų priešoperacinį įvertinimą.

Keywords: Leiomyosarcoma; imaging features; inferior vena cava; retroperitoneal tumor.

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Conflict of interest statement

The Autrhors confirm that this work is original and has been published only in a pre-print service (www.researchsquare.com), the DOI is the following: https://doi.org/10.21203/rs.3.rs-1918169/v1.

Figures

Figure 1.
Figure 1.. Ultrasonography of abdomen (A) with color Doppler flow imaging (B) shows a heterogeneously hypoechoic circumscribed lesion in the upper abdomen in right paramedian location with no significant internal vascularity.
Figure 2.
Figure 2.. Computed tomographic axial images of noncontrast (A), arterial phase (B), portal venous phase (C) and delayed phase (D) show an isodense (A) retroperitoneal lesion right paramedian in location, in close contact with the abdominal aorta showing inhomogeneous areas of contrast uptake on arterial phase (B) with homogeneous enhancement on portal venous (C) and delayed phases (D). The lumen of inferior vena cava at the site of maximum contact is imperceptible.
Figure 3.
Figure 3.. Computed tomographic coronal (A) and sagittal (B) reformatted images in portal venous phase show a near homogeneously enhancing retroperitoneal lesion in anterior relation to the infrarenal inferior vena cava towards the right of the midline. Proximal and distal segments of the inferior vena cava show normal contrast opacification with no intraluminal component.
Figure 4.
Figure 4.. MRI axial T2W (A), T2W TRUFI (B), precontrast (C) and post contrast (D) T1W fat saturated VIBE images show a circumscribed lobulated retroperitoneal lesion on the right side of midline appearing hyperintense on T2W (A) and hypointense on T1W (C) showing near homogeneous contrast enhancement (D). In axial DWI (E) image and corresponding ADC map (F), the lesion shows restricted diffusion. Few T2W hyperintense nonenhancing cystic areas are seen within the lesion.
Figure 5.
Figure 5.. MRI axial T1W fat saturated VIBE (A) and T2W (B) images acquired in prone position show persistent nonvisualization of the lumen on inferior vena cava at the site of maximum contact.
Figure 6.
Figure 6.. MRI coronal T2W (A) and sagittal post contrast T1W fat saturated VIBE (B) images show a circumscribed near homogeneously enhancing lesion along the anterior wall of infrarenal inferior vena cava with no intraluminal filling defect.
Figure 7.
Figure 7.. PET CT axial (A) and coronal (B) images show mild FDG uptake by the lesion with no hypermetabolic lymph nodes.
See this image and copyright information in PMC

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