Diagnosis and management of leiomyosarcoma arising from ovarian vein: Case report and literature review

Abstract

Primary leiomyosarcomas arising from the ovarian vein are extremely rare and are associated with high morbidity. A 49-year-old nulliparous woman presented with a left lower abdominal mass. Although extremely rare, the radiological appearance is able to preoperatively identify malignant retroperitoneal masses, such as leiomyosarcomas originating from the ovarian vein; thus, the patient underwent a simple total excision of the mass-adjacent organs, as well as complete resection of the uterus, bilateral adnexae and the left ovarian vein. Adjuvant postoperative combination chemotherapy with gemcitabine and docetaxel was administered. At 22 months, she had no recurrence or metastasis. Delayed diagnosis and high metastatic potentiality are associated with the high morbidity of vascular leiomyosarcomas. The preoperative radiological appearance is useful for early diagnosis, and radical treatment with adjuvant chemotherapy consisting of gemcitabine and docetaxel may improve the poor prognosis of patients with leiomyosarcoma arising from the ovarian vein.

Preoperative diagnosis by three-dimensional angiography of a leiomyosarcoma arising from the left ovarian vein

“…We did not plan any adjuvant postoperative treatments as the patient was of advanced age and had a poor performance status. It has been reported that adjuvant treatment, such as anthracycline-based chemotherapy and combination chemotherapy with gemcitabine and docetaxel, is beneficial for survival; however, there is no evidence that adjuvant chemotherapy or radiotherapy improves the prognosis of patients with leiomyosarcoma 3 10. Although we observed no evidence of recurrence after surgery, careful follow-up of this patient is required because vascular leiomyosarcomas often do have distant metastases.…”

Leiomyosarcoma of the Right Gonadal Vein: Review of the Approach and Prognostic in a Rare Case

“…A venous leiomyosarcoma should be suspected in multiple leiomyomas and in cases of a rapidly growing pelvic or fibroid mass [2–5, 7]. The tumour may be associated with abdominal pain, but patients are mainly asymptomatic, particularly if the lesion originates in the retroperitoneal space, in which case diagnosis is delayed and the prognosis is worse [1, 2].…”

“…CT outlines the tumour boundaries before performing a surgical procedure [1–6]. CT reveals large masses with heterogeneous contrast, cystic and necrotic components, and vascular hypertrophy [3, 5]. An MRI may also be useful for the diagnosis if a venous leiomyosarcoma is suspected [2].…”

Gonadal vein leiomyosarcoma: A case report with radiological findings

“…The claw sign, as demonstrated in our case, suggest that the tumor is intravascular in origin. With the advance of high spatial resolution of multi-detector CT over the last few decades, multiplanar reconstruction is possible, and these methods are useful in demonostrating the relationship between a mass and vessel, as well as detecting the tumour or venous thrombi (1)(2)(3)(4)(5). Combining the anatomical location and imaging features of the mass allows us to make the pre-operative diagnosis confidently.…”

“…Gonadal vein LMS is extremely rare and only ten cases have been reported in the literatures (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”