Leiomyosarcoma of Inferior Vena Cava Arising from the Confluence of Right Adrenal Vein Masquerading as a Suprarenal Mass - A Case Report

Abstract

Leiomyosarcoma (LMS) is a malignant mesenchymal tumour, which originates from the smooth muscle cells. Leiomyosarcoma of vascular origin most commonly originates from inferior vena cava (IVC). Around 400 cases of IVC leiomyosarcoma were reported in literature till date. Here we report a case of a 58-year-old male diagnosed to have right large palpable supra renal mass. Contrast enhanced computed tomography (CECT) of abdomen and pelvis revealed a well-defined soft tissue mass measuring around 10 cms with heterogeneous post contrast enhancement at right suprarenal region with a clinical differential diagnosis of adreno cortical carcinoma and retroperitoneal leiomyosarcoma was made. Intra-operatively right adrenal gland was normal, and the mass was seen arising from the side wall of IVC at the confluence of right adrenal vein. Complete excision of mass done, followed by repair of IVC rent. Histopathological examination showed leiomyosarcoma. Adrenal gland was normal, margins were free of tumour and immunohistochemistry (IHC) was positive for caldesmon and smooth muscle actin (SMA). Patient was on follow up for the past 1 year without local recurrence or distant metastasis.