Diagnosis and management of rare inferior vena cava leiomyosarcoma guided by a novel minimally invasive vascular biopsy technique

Abstract

Primary vascular tumors such as vascular leiomyosarcomas are rare, but exhibit markedly different characteristics than tumors that invade the vasculature from a secondary source. Establishing a diagnosis is essential in determining the appropriate treatment plan, but obtaining a histologic specimen may prove challenging and carry significant risks. Minimally invasive endovascular biopsy techniques can be pivotal in the diagnosis-and thus in the management-of vascular tumors. We present a case of a primary inferior vena cava leiomyosarcoma, not able to be adequately assessed by noninvasive imaging and deemed too risky to be approached with traditional percutaneous biopsy techniques. Accurate diagnosis of such tumors is critical, as the success of surgical resection, although high risk, depends greatly upon the type, location, and extent of malignancy.

Challenges in diagnosing aortic leiomyosarcoma post endovascular repair of abdominal aortic aneurysm

“…Balaney et al 9 proposed a novel endovascular catheter-based aspiration technique as a minimally invasive approach to diagnosis. The recommended therapy involves bloc resection of the tumor-involved aorta and surrounding tissues, followed by interposition grafting; however, because of the late diagnosis, this intervention is usually not feasible.…”

Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection?

“…Unlike the procedure for other STSs, percutaneous biopsy for vascular sarcoma is associated with an increased risk of massive hemorrhage, ranging from 0.1 to 8.3% [9]. A new minimally invasive vascular biopsy technique using catheter-based aspiration of an intravascular tumor is an alternative, with lower risk of vascular injury [10]. The diagnosis of LMS is confirmed by immunohistochemistry with positive staining of a-smooth muscle actin, desmin and heavy-caldesmon on the samples [11].…”