Eur J Cardiothorac Surg 2003;23:241
© 2003 Elsevier Science NL
Images in cardio-thoracic surgery |
Inferior vena cava leiomyosarcoma
Poo-Sing Wonga*,
Chon-Kar Leowb,
Poh-Sun Gohc,
Norman Chand
a Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
b Division of Hepato-Biliary Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
c Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
d Department of Pathology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
Received 4 October 2002;
received in revised form 5 November 2002;
accepted 7 November 2002.
* Corresponding author. Tel.: +65-67722060; fax: +65-67766475
e-mail: surwps{at}nus.edu.sg
Key Words: Leiomyosarcoma • Inferior vena cava
A 62-year-old woman presented with abdominal distension and swelling of her ankles. Magnetic resonance imaging showed a 4 cm diameter tumour mass in the inferior vena cava (IVC) from just above the renal veins extending up through the intrahepatic IVC into the right atrium (Fig. 1)
. Intra-operative Doppler ultrasound confirmed no flow in all three hepatic veins. The mass was seen extending from the IVC into the left hepatic vein up into segment II of the liver. The decision was therefore made not to proceed. Biopsy showed this to be a primary vascular leiomyosarcoma (Fig. 2)
. As this tumour is not known to be chemo- or radio-sensitive the patient was treated with diuretics. At 3 months following surgery she had progressive abdominal distension and swelling of her lower limbs.
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Fig. 1. Magnetic resonance imaging showing a large mass within the inferior vena cava starting just distal to the entry of the renal veins extending proximally into the lumen of the right atrium.
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Fig. 2. Bouin fixed, cell block, immunoperoxidase staining with smooth muscle actin, showing strong, diffuse cytoplasmic staining with smooth muscle actin in this spindle cell neoplasm, in keeping with a smooth muscle origin.
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