Leiomyosarcoma of the Inferior Vena Cava—A Case Report

Abstract

The authors report a rare case of leiomyosarcoma of the inferior vena cava (IVC) with an unusually long survival time of more than five years without signs of local or systemic tumor recurrence up to today. The diagnostic and therapeutic problems are discussed and the relevant literature is considered. The diagnosis was assessed by computed tomographic scan. The surgical treatment consisted of resection of the tumor (located in the inferior and middle third of the IVC), together with the right kidney. After proximal ligature of the left kidney vein no reconstruction of the resected segment of the IVC was performed.Owing to an adequate collateral venous drainage the kidney function remained normal. The prognosis of this rare tumor is reported to be quite poor with a resectability rate of about 60% and a mean survival time of two to three years after surgery. Alternative treatment modalities such as irradiation or chemotherapy are considered to be of no additional benefit. Case ReportA so far healthy sixty-nine-year-old woman was admitted to the hospital in the summer of 1985 with a complaint of bilateral edema of the lower extremities and vague abdominal pain since the summer of 1984. The cavography showed a complete obstruction of the inferior vena cava (IVC) and both iliac veins with a well-developed collateral circulation to the superior vena cava such as the lumbar and vertebral plexus and the azygos and hemiazygos veins (Figure 1 ).Results from the laboratory investigations were in the normal ranges. With the diagnosis of a thrombosis of the IVC the patient was anticoagulated and dismissed. She was, however, readmitted to the hospital for a progressive weight loss of more than 30 pounds in January, 1986. The edema of the lower extremities had disappeared. On physical examination a firm mass was palpable in the right lower abdomen. The laboratory findings were normal except for an elevated blood sedimentation rate of 110