Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis

Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

doi:10.1097/md.0000000000008581

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…[ 20 ] To date, there is only one report describing CEUS imaging features for the diagnosis of venous LMS. [ 21 ] The CEUS imaging characteristics in our case and literature both demonstrate a rapid, high-level, heterogenous wash-in and wash-out, which is probably caused by tumor heterogenous perfusion or necrosis. In this case, there was a clear margin during the enhancement, and this may correspond to the pseudocapsule of the tumor.…”

Section: Discussionmentioning

confidence: 57%

Primary external iliac vein leiomyosarcoma in a young female diagnosed by contrast-enhanced ultrasound

Xiao-chen

Gao²,

Zhang³

2020

Medicine

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Rationale: Venous leiomyosarcoma (LMS) is a malignant tumor arising from the smooth muscle cell of the vein wall. The diagnosis of venous LMS is usually delayed owing to its rarity, absence of serological markers, and mimicry with deep vein thrombosis (DVT). Herein, we report a case of a primary external ilian vein LMS characterized by long-term, unexplained DVT in the left lower limb. Contrast-enhanced ultrasound (CEUS) played a crucial role in the preoperative diagnosis. No improvement was observed in the lower limb status; a rapid, high-level, heterogeneous wash-in and wash-out mass of the vein, as seen with CEUS, could indicate angiogenic malignancy. CEUS also helped evaluate the percent of intratumoral necrosis, which is an important parameter for predicting the prognosis. Patient Concerns: A 37-year-old Chinese women presented to the Vascular Surgery Department of our hospital for accurate diagnosis of her condition. She began experiencing edema and pain in her left leg 2 years ago. She was diagnosed with DVT in the left lower extremity and was administered anticoagulant therapy since then. However, her symptoms started to aggravate 8 months ago. Diagnoses: The laboratory results including D-dimer, prothrombin time (PT), activated partial thrombin time (APTT), and prothrombotic conditions screening were within normal ranges. A pelvic ultrasound detected a heterogeneous, hypoechoic mass compressing the external iliac vein and obstructing the venous drain of the lower extremity. The mass showed a rapid, high-level, heterogeneous wash-in and wash-out on CEUS, which suggested angiogenic malignancy. Contrast-enhanced CT (CECT) confirmed the result of CEUS but revealed no metastasis. Interventions: She underwent complete surgical removal of the tumor, which was resected successfully. There was no infiltration in the inguinal nodes sent for the study. Outcomes: Pathological examination and immunohistochemistry confirmed that the mass was a well-differentiated LMS originating from the external iliac vein. There was no sign of local recurrence or distant metastasis during a 12–month follow-up. Lessons: Effective imaging techniques and differential diagnosis of venous LMS is vital and should be considered for patients with chronic thrombosis presenting with normal laboratory results.

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Section: Discussionmentioning

confidence: 57%

Primary external iliac vein leiomyosarcoma in a young female diagnosed by contrast-enhanced ultrasound

Xiao-chen

Gao²,

Zhang³

2020

Medicine

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“…The first description of venous LMS was presented by Perl in 1871. This malignancy originates from the artery smooth muscle layer [ 11 ]. The most frequent site for LMS is the retroperitoneum, accounting for up to 50% of all cases, 50% of reported vascular LMS originates from the vena cava inferior and 15% from the iliac veins.…”

Section: Discussionmentioning

confidence: 99%

“…This approach can prolong survival and improve quality of life. Although a multidisciplinary treatment is advised, the effectiveness of adjuvant radiotherapy, chemotherapy, and hormonal therapy is unknown [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Multifocal Sarcoma Mimicking Superficial Vein Thrombosis of the Leg: A Case Report

Dziekiewicz

Obara

Makowski³

2022

Am J Case Rep

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Patient: Female, 61-year-old Final Diagnosis: Leiomyosarcoma Symptoms: Pain • redness • tenderness • warmth Medication: — Clinical Procedure: Excision of tumor Specialty: Surgery Objective: Unusual clinical course Background: Leiomyosarcoma is a common tumor found in soft tissue. In relation to the vascular system, leiomyosarcoma appears as the most common malignancy characterized by poor prognosis. Leiomyosarcomas of the leg large vessels often occur late, and their appearance can imitate vein thrombosis with symptoms such as soft tissue swelling or mild pain, and can be misdiagnosed. Peripheral vascular leiomyosarcomas are rare. Especially leiomyosarcomas of the great saphenous vein are uncommon. The tumors develop on the media basis and grow from endovascular to exovascular order. Distant metastasis can be identified and worsen prognosis. Case Report: We present a case of a 61-year-old female patient with varicose vein disease complicated by recurrent superficial vein thrombosis. After 2 months of conservative treatment, while waiting for admission to the department of surgery, she developed additional symptoms. Clinical examination on the day of admission revealed several tumors along and near the great saphenous vein on the left limb below the knee. The diagnosis of leiomyosarcoma was confirmed after the surgery, involving excision of the saphenous vein, including tumors formed on its course. Preoperative clinical and ultrasound findings did not suggest malignancy. Conclusions: Leiomyosarcoma of the great saphenous vein is an extraordinarily rare tumor originating from the middle layer of the vessel, mimicking unspecific symptoms and complicating and delaying diagnosis. In every case of vascular or perivascular lesions, a detailed examination and diagnosis it is required, and even unlikely clinical scenarios should be considered.

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“…The female and male distribution is equal and it mainly affects patients in their sixth and seventh decade of life (Cangiano et al, 2017). They often present indolent symptoms, such as soft tissue swelling and mild pain, leading to late and complex diagnosis (Zhang et al, 2017). In approximately 10–25% of cases distant metastasis are identified at the time of diagnosis (Bibbo & Schroeder, 2011).…”

Section: Discussionmentioning

confidence: 99%

Combined double superficial circumflex iliac artery perforator flap with lymphatic tissue preservation and lymphovenous anastomosis for lymphatic sequelae prevention in thigh defect reconstruction: A case report

et al. 2021

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The thigh region is often site of soft tissue tumors development. Leiomyosarcoma, in particular, is a malignant tumor that, if not promptly treated, presents a growth rate that often results in large masses. The safest treatment in these cases is margin-free extensive surgical resection. This leads to rather large defects that in a delicate region, such as the medial thigh, implies a series of possible complications from the lymphatic point of view. In this region run major lymphatic vessels, appointed to drain the whole leg. Now that one is aware of this issue, the best solution is trying to obtain an efficient reconstruction and preventing the development of postoperative lymphedema and lymphocele. Here, we present a case of great saphenous vein leiomyosarcoma resection in the right medial thigh reconstructed by means of two superficial circumflex iliac artery perforator (SCIP) flaps with lymphatic tissue preservation, combined with preventive lymphovenous anastomosis (LVA). A 67-years-old woman presented a 22 × 16 cm soft tissue defect after the surgical excision. To fill the defect, we resorted to a larger SCIP flap island, supplied by both the superficial and deep branches of the superficial circumflex iliac artery anastomosed in perforator-to-perforator fashion, and to a smaller SCIP flap island supplied only by the superficial branch. Before surgery, the lymphatic vessels running in the flaps area were identified with indocyanine green lymphography and were carefully preserved during the harvest procedure. They were then transferred with the surrounding tissue and orientated in order to match the lymphatic flow direction, providing further fluid drainage. To boost the lymphatic drainage, an LVA was also performed at the superior-edge-of-the-knee incision point joining a functioning lymphatic vessel to a nearby reflux-free vein. The postoperative course was uneventful and at 7 months follow-up, the patient showed good cosmetic and functional outcomes with no swelling and no signs of tumor relapse. This report provides a series of technical insights and adds further evidence to support the efficacy of this procedure for management of soft tissue defects in the medial thigh region.Mario F. Scaglioni and Matteo Meron should be considered as first co-authors.

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Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis

Cited by 6 publications

References 14 publications

Primary external iliac vein leiomyosarcoma in a young female diagnosed by contrast-enhanced ultrasound

Primary external iliac vein leiomyosarcoma in a young female diagnosed by contrast-enhanced ultrasound

Multifocal Sarcoma Mimicking Superficial Vein Thrombosis of the Leg: A Case Report

Combined double superficial circumflex iliac artery perforator flap with lymphatic tissue preservation and lymphovenous anastomosis for lymphatic sequelae prevention in thigh defect reconstruction: A case report

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