Thrombectomy of the inferior vena cava from recurrent low-grade endometrial stromal sarcoma: Case report and review of the literature

Veroux, Massimiliano; Nicosia, Alfio; Bonanno, Maria Giovanna; Tumminelli, Maria Giuseppina; Milone, Pietro; Petrillo, Giuseppe

doi:10.1002/1096-9098(200005)74:1<45::aid-jso11>3.0.co;2-k

Cited by 12 publications

(7 citation statements)

References 13 publications

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“…The worm-like or marginal nodules in ESS were once considered invasive features representing intra-lymphatic or intravascular involvement [15]; however, in our study, they appeared in both high-grade and low-grade ESS and showed no statistically significant difference between the two groups. ESS could show great vessel invasion into the inferior vena cava, heart or pulmonary vessels [31–34], but only one of our cases demonstrated uterine vein invasion on MR imaging. This may be because the cohort included early stage cases.…”

Section: Discussionmentioning

confidence: 99%

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

et al. 2019

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Background Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that features different prognoses for its high- and low-grade subtypes. We investigated the diagnostic accuracy of magnetic resonance (MR) imaging in diagnosing and differentiating between high- and low-grade ESS. Methods We retrospectively reviewed the preoperative pelvic MR images of consecutive patients who received histologically confirmed diagnoses of high-grade ESS (n = 11) and low-grade ESS (n = 9) and T2-hyperintense leiomyoma (n = 16). Two radiologists independently evaluated imaging features in T1-, T2-, and diffusion-weighted and contrast-enhanced MR images. Statistical analysis included Mann-Whitney tests and Fisher’s exact test, with sensitivity, specificity and diagnostic accuracy of imaging features. Results High-grade ESS was associated with significantly more extensive necrosis and hemorrhage and distinct feather-like enhancement compared with low-grade ESS (P < .05 for all). The feather-like enhancement pattern yielded a diagnostic accuracy of 95%, sensitivity of 91%, and specificity of 100% in differentiating high-grade from low-grade ESS. This imaging characteristic was significantly superior to the necrosis (80%, P = .033) or hemorrhage (75%, P = .007). Both high- and low-grade ESS demonstrated T2 hypointense bands, marginal nodules, intratumoral nodules, and worm-like intra-myometrial nodules, and their tumor apparent diffusion coefficient (ADC) values were significantly lower than those of T2-hyperintense leiomyomas (P < .001). Conclusions Diffusion-weighted MR imaging is useful in diagnosing ESS against T2-hyperintense leiomyomas, and contrast enhancement aids in further differentiating between high- and low-grade ESS.

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Section: Discussionmentioning

confidence: 99%

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

et al. 2019

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“…Endometrial stromal sarcoma tends to spread throughout the lymph nodes and venous system but rarely involves the large vessels or the heart [13].…”

Section: Discussionmentioning

confidence: 99%

Low-grade endometrial stromal sarcoma with inferior vena cava tumor thrombus and intracardiac extension

Valdespino¹,

Ramón²,

Cordova³

et al. 2017

Gen Med Open

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The endometrial stromal sarcoma is a rare neoplasm of the uterine origin. Intracardiac metastasis form the low-grade endometrial stromal sarcoma is an extremely rare event. A case of a patient who underwent surgical resection of metastatic tumors of the low-grade endometrial stromal sarcoma in the right atrium is described in the present report. Cardiac malignancies account for less than 1% of cardiac surgery and around 0.1% of cardiac echo graphic studies. The presence of metastatic tumor to the heart usually indicates widespread metastases. Lung carcinomas are the most commonly encountered tumor followed by breast and pancreas cancer and melanoma.We show the case report of a woman with endometrial stromal sarcoma who developed a right heart failure, lower extremity edema, dyspnea and orthopnea after the initial step of comprehensive surgery and radiotherapy. Heart metastases was diagnosed by computed tomography and echocardiophy after a palliative metastasectomy; the patient received chemotherapy and hormotherapy without showing response, re-developing a heart metastasic tumor. Tumoral activity was the cause of her death.It is very difficult to standardize care procedures for these patients due to the rarity of this condition. However, it is possible that aggressive therapy (surgery plus radiotherapy and chemotherapy) may lengthen patients survival and improve life quality.

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“…Endometrial stromal sarcoma constitutes approximately 0.2% to 1% of all uterine malignancies and approximately 10% of uterine sarcomas; its annual incidence is approximately 2 in 1,000,000 women. 6,7 Its clinical recognition can be difficult, and it is often mistaken for a leiomyoma until a true diagnosis is made postoperatively. Histologic examiners miss the diagnosis of early-stage, low-grade endometrial stromal sarcoma at a reported rate of up to 40%, which results in therapeutic delay.…”

Section: Discussionmentioning

confidence: 99%

Endometrial Stromal Sarcoma Metastatic from the Uterus to the Inferior Vena Cava and Right Atrium

Scher¹,

Nghiem²,

Aziz³

et al. 2015

Texas Heart Institute Journal

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Endometrial stromal sarcoma metastases usually occur within the pelvis and rarely involve the great vessels or the heart. We present the case of a 55-year-old woman who was referred for endovascular therapy to treat presumed thrombosis of the inferior vena cava. The suspected thrombus was recalcitrant to endovascular removal with use of an AngioVac venous drainage device. Results of an intraprocedural transvenous biopsy revealed the mass to be the intravascular extension of an endometrial stromal sarcoma. The patient underwent surgical excision of the tumor, and, shortly thereafter, a hysterectomy and salpingo-oophorectomy. This complex case highlights both the rarity of malignancy masquerading as caval thrombus and the importance of multispecialty collaboration.

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Thrombectomy of the inferior vena cava from recurrent low-grade endometrial stromal sarcoma: Case report and review of the literature

Cited by 12 publications

References 13 publications

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma

Low-grade endometrial stromal sarcoma with inferior vena cava tumor thrombus and intracardiac extension

Endometrial Stromal Sarcoma Metastatic from the Uterus to the Inferior Vena Cava and Right Atrium

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