Diagnostic and management strategies for retroperitoneal leiomyosarcoma invading the inferior vena cava: a case report

Abstract

Background: Retroperitoneal leiomyosarcoma represents a poor-prognosis malignancy for which current clinical treatment options remain limited. This study may further help bridge the gap in available therapeutic modalities.

Case presentation: This case report describes a 75-year-old female patient who was admitted to the hospital with right lower abdominal pain and imaging studies suggesting a retroperitoneal mass and consideration of leiomyosarcoma. After the diagnosis was confirmed by imaging analysis combined with puncture biopsy, the patient received chemotherapy with adriamycin (75 mg/m²) and dacarbazine (200 mg/m²) to shrink the tumor once every 3 weeks for 4 cycles, which resulted in tumor shrinkage, and then underwent resection of the retroperitoneal leiomyosarcoma combined with resection of the inferior vena cava lesions. The retroperitoneal tumor involving the inferior vena cava (IVC) was completely resected without requiring IVC reconstruction during the surgical procedure. Final histopathological analysis confirmed the diagnosis of leiomyosarcoma. The patient demonstrated an uneventful postoperative recovery with no surgical complications, and subsequent follow-up evaluations revealed no evidence of disease recurrence, resulting in substantial improvement in the patient's quality of life on the basis of standardized oncology performance metrics.

Conclusions: This case emphasizes the critical role of imaging in diagnosis and surgical strategies. This study provides new ideas for the complete resection of retroperitoneal leiomyosarcoma. More studies are needed in the future to optimize the treatment strategy for this type of tumor.

Keywords: Inferior vena cava; Ovarian vein; Radiotherapy; Retroperitoneal leiomyosarcoma; Surgery.

Fig. 1

An episode of care for this patient. This figure shows the process from diagnosis to treatment and prognosis. The numbers in the middle of the image represent the corresponding time, whereas the content of the box below each corresponding time is the image, procedure, or prognosis

Fig. 2

Patient preoperative imaging data. a CT with CTA revealed retroperitoneal smooth muscle sarcoma (RPLS) invading the inferior vena cava, with the left iliac vein connecting to the left ovarian vein (LOV) and left renal vein (LRV); b PRLS did not invade the abdominal aorta, right kidney, and right renal vein. c MRI confirmed LOV-LRV confluence without tumor invasion. d MRI revealed LOV extending into the pelvis, uninvolved by RPLS. The vascular pathways and tumor margins were clearly delineated across the imaging modalities

Fig. 3

Procedure for removing the mass during surgery. e The abdominal cavity is opened to reveal the mass, and the mass is stripped along the left edge of the abdominal aorta. f The branch vessels are ligated to reveal the right edge of the mass and to protect the right ureter. g The inferior vena cava at both ends of the mass is freed, and the inferior vena cava is cut off at the distal end of the mass, with sutures given at the distal end. h The occluder is closed proximally in the inferior vena cava, and the mass is removed

Fig. 4

Postoperative images of the patient are shown along with preoperative and postoperative pathology images. i Postoperative CT plain scan of the abdomen; postoperative retroperitoneal smooth muscle sarcoma (RPLS) was completely resected, and the left ovarian vein (LOV) entered the left renal vein (LRV). j Preoperative puncture specimen suggestive of smooth muscle sarcoma accompanied by some tissue necrosis. k) Postoperative pathology further demonstrated that the mass was a smooth muscle sarcoma