Background: Vascular leiomyosarcoma is a rare but most common vascular tumor of the inferior vena cava.Case presentation: We present the case of an incidentally diagnosed extraluminal leiomyosarcoma of the inferior vena cava in a 62 year old patient who presented with abdominal pain following blunt trauma. Ultrasonography showed a lobulated hypoechoic lesion in the upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a circumscribed lobulated near homogeneously enhancing retroperitoneal lesion in anterior relation to the infrarenal inferior vena cava, right paramedian in location with imperceptible vena caval lumen at the site of maximum contact. In positron emission tomography (PET) CT the lesion showed mild fluorodeoxyglucose (FDG) uptake with no distant metastases. CT guided biopsy with immunohistochemical analysis showed leiomyosarcoma. Patient underwent surgical resection with inferior vena cava reconstruction.Conclusions: Leiomyosarcoma of the inferior vena cava is a rare tumor of vascular origin. Imaging plays an imperative role in the diagnosis and preoperative evaluation. This article also provides a comprehensive literature review of the radiological features of inferior vena caval leiomyosarcoma that would aid in optimal preoperative characterization and evaluation.
Presacral space is a potential space between the rectum anteriorly and lumbosacral spine posteriorly containing derivatives from various primitive germ cell types which serve as origin to a myriad of tumors. Imaging plays a vital role in diagnosis, characterization, assessing extent and evaluation of spread. We present a series of six cases of pediatric presacral tumors with intraspinal extension. The series comprises of an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing’s sarcoma of the ilium which can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal, osteogenic origin. In spite of overlapping imaging features, careful retrospective observation revealed few distinctive features that would aid in optimal characterization of tumors with a fair degree of certainty.In summary, the salient imaging features that aid in differentiation are the epicentre of the tumor, pattern and degree of bone involvement, status of sacral foramina and neural elements and internal characteristics such as presence of fat, calcification, hemorrhage, necrosis, etc.
Vascular leiomyosarcoma is a rare but most common vascular tumor of the inferior vena cava. We present the case of an incidentally diagnosed extraluminal leiomyosarcoma of the inferior vena cava in a 62 year old patient who presented with abdominal pain following blunt trauma. Ultrasonography showed a lobulated hypoechoic lesion in the upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a circumscribed lobulated near homogeneously enhancing retroperitoneal lesion in anterior relation to the infrarenal inferior vena cava, right paramedian in location with imperceptible vena caval lumen at the site of maximum contact. In, positron emission tomography (PET) CT the lesion showed mild fluorodeoxyglucose (FDG) uptake with no distant metastases. CT guided biopsy with immunohistochemical analysis showed leiomyosarcoma. Patient underwent surgical resection with inferior vena cava reconstruction. This article also provides a comprehensive literature review of the radiological features of inferior vena caval leiomyosarcoma that would aid in optimal preoperative characterization and evaluation.
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