Metastatic Vascular Pleomorphic Leiomyosarcoma in a Previously Treated Cervical Carcinoma Patient: A Diagnostic Dilemma

Abstract

Vascular leiomyosarcoma is a rare malignant tumour of the smooth muscle connective tissue. Patients are usually asymptomatic in the early stages and only present when the lesion causes compressive or obstructive effects or has metastasized. We report a case of vascular pleomorphic leiomyosarcoma in a 70-year-old lady with a background history of squamous cell carcinoma of the cervix. She presented with a three-month history of low back pain, which radiated to the anterior bilateral thigh. Initial radiological findings revealed metastatic lesions involving the spine and lungs. Two spinal biopsies done were inconclusive. Increasing severity of pain over the right thigh prompted further imaging, which revealed bilateral femoral lesions. The patient underwent surgery which involved excision of the tumour in the right proximal femur with skeletal reconstruction using megaprosthesis. Proximal femoral nail was performed for the left femur. Intraoperatively, tumour was noted at the anteromedial aspect of the proximal right thigh surrounding the superficial femoral vein. Histopathological report of the right thigh mass finally confirmed a diagnosis of vascular pleomorphic leiomyosarcoma. The patient presented four months later with bilateral pulmonary embolism with deep vein thrombosis in addition to progression of the disease.

Abnormal growth of a pleomorphic leiomyosarcoma originating from the mesenteric vein associated with poor outcome after curative-intent resection: a case report

“…Vessel-derived LMSs account for < 2% of all the LMSs. In general, this type of tumor arises from large vessels such as the IVC, pulmonary vein, and femoral vein [ 9 – 11 ]. Owing to the nature of the vessel-derived LMS, it frequently metastasizes to distant sites, such as the lungs and liver via the vessel stream [ 10 – 13 ].…”

“…Vessel-derived LMSs account for < 2% of all the LMSs. In general, this type of tumor arises from large vessels such as the IVC, pulmonary vein, and femoral vein [9][10][11]. Owing to the nature of the vessel-derived LMS, Fig.…”

“…3 The tumor is predominantly located in the descending colon and colonic mesentery and is hardly included in the intestinal mesentery Fig. 4 Immunohistochemical analysis reveals that the intravascular tumor is diffusely positive for desmin, but extravascular is negative it frequently metastasizes to distant sites, such as the lungs and liver via the vessel stream [10][11][12][13]. Previously, the rates of 5-year disease-free survival and overall survival (OS) were reported to be approximately 40% and 75%, respectively, in cases of an LMS derived from IVC [14].…”