Background and Objectives We operated on three patients with leiomyosarcoma of the inferior vena cava. Methods Complete excision was possible in all three patients. Results One patient developed widespread metastasis at 23 months, one patient is alive with no evidence of disease at 70 months, and one patient is alive at 15 months. The third patient had subcutaneous and pulmonary metastases at the time of presentation, which are radiologically nondetectable at present following postoperative chemotherapy. Conclusions The clinicopathologic features, prognostic factors, and treatment of 130 cases found in a comprehensive literature search and our three cases are reported. J. Surg. Oncol. 1997;65:205–217. © 1997 Wiley‐Liss, Inc.

Aortoiliac or infrainguinal disease diagnosed in patients less than 50 years of age portends a poorer outcome than does similar disease in an older patient population.

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Few data are available on long-term follow-up of arterial segments subjected to thrombolysis. We reviewed all cases of vascular occlusion treated with urokinase to identify early success and determine the influence of postlysis intervention and the nature of the thrombosed segment (i.e., artery vs graft) on long-term patency. Methods: Data on 134 cases (58 arteries, 76 grafts) treated with high-dose urokinase infusion in the lower limbs over a 7 -year period were analyzed. Limbs were divided into five groups on the basis of therapy after lytic infusion to determine long-term efficacy: group I, success with no additional therapy; group II, percutaneous angioplasty alone; group III, limited surgical procedure (operative angioplasty, jump graft); group IV, extensive procedure (new bypass); and group V, revascularization after lytic failure. Long-term results were assessed by life-table analysis and groups compared by log-rank test (Mantel-Haenszel). Results: Initial patency was established in 87 (64.9%) of 134 cases with 5 deaths (3.7%), 11 amputations (8.2%), and 16 complications (11.9%). Follow-up was available in 68.6% of cases for a mean of 10.9 months. No difference was seen between grafts and native arteries. Patency was analyzed at 6, 12, 18, and 24 months. The 24-month patency rate after lysis alone (group I -25.9%) was inferior (p < 0.05) to results after lysis and any subsequent intervention (groups II, III, and IV). The type of intervention did not influence subsequent patency. Twenty-four-month patency of procedures performed after failed thrombolysis (group V, 41.4%) was not different from those after successful lysis (groups I to IV). Twenty-four-month patency in groups II and III (minor interventions, 62.9%) was not significantly different from that of groups IV and V (major interventions, 53.2%) (p > 0.25). Conclusions: Operative intervention is required to produce long-term arterial patency, even after successful thrombolysis. No statistically significant benefit of thrombolysis on vascular patency was seen in our series.

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Light, histochemical, and ultrastructural features of a myoepithelial cell adenoma of the parotid gland are described. Ultrastructurally, the neoplasm was almost entirely composed of myoepithelium. The spindle-shaped myoepithelial cells and their processes were filled with longitudinally oriented myofilaments with characteristic densities along their course and marginal attachment plaques. The tumor cells were interconnected by desmosomes. The role of myoepithelium in the genesis of some salivary gland tumors is discussed.

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