Angiography in leiomyosarcoma of the inferior vena cava—report of two cases

Abstract

Two patients with leiomyosarcoma of the suprarenal inferior vena cava are presented. In one case the tumour was misinterpreted as intrahepatic at angiography. In the second case an extrahepatic location was suggested after repeated angiography. The diagnosis should be borne in mind when a large hypovascular mass appears to be located centrally in the liver at coeliac angiography and when ultrasound examination has revealed its solid nature.

Leiomyosarcoma of the inferior vena cava: A clinicopathologic review and report of three cases

“…Ultrasonography was used to rule out hepatobiliary and pancreatic pathology and to confirm the presence of a tumor. The tumor appeared as a mass with homogenous or heterogenous sound patterns [5,26,28,39,36,41,48,[60][61][62][63][64][65][66][67][68]. Doppler ultrasound gave information about patency of the portal or systemic venous system [41,48,65].…”

“…Computerized tomography (CT scan) and nuclear magnetic resonance (NMR) confirmed the presence of a tumor, its pattern of growth, relationship to the surrounding structures, and the presence of caval obstruction. On CT scan, the tumor appeared as low density, solid, or heterogenous mass compressing or silhouetting, involving or arising from the IVC [5,24,26,29,34,[38][39][40][41]48,[60][61][62][63][65][66][67][68][69][70][71][72][73][74][75]. Mild to moderate contrast enhancement, especially peripherally between the intraluminal growth and the cava wall, was noted [26,38,60,62,[73][74][75].…”

“…On angiography, LMS of the IVC exhibited variable degrees of vascularity [14,15,24,26,[29][30][31]36,38,44,56,59,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78]. Hypervascular tumors derived their blood supply from the hepatic artery or its branches, adrenal, lumbar, gastric, pancreaticoduodenal, or gastroduodenal artery.…”

“…Percutaneous needle biopsy allowed identification of the histologic subtype of the tumor but not the organ of origin [24,34,38,48,66,67,79].…”

Asymptomatic Leiomyosarcoma of the Inferior Vena Cava

“…Visceral angiography has been used in such cases but may be misleading in suggesting an intrahepatic tumor. However, in cases with a hypovascular tumor in the upper part of the abdomen, leiomyosarcoma of the inferior vena cava should be considered, especially if the tumor proves to be solid at ultrasonography (10). Computed tomography offers good delineation of tumors in the region of the inferior vena cava, but even with CT it may be difficult to decide the true origin of the tumor (5, 8,15,20).…”