Leiomyosarcoma of the great saphenous vein (vena saphena magna) with granular cell change: Report of a superficial neoplasm

Abstract

The great saphenous vein (GSV) corresponds to the main superficial large-caliber vessel affected by leiomyosarcoma (LMS). Given its superficial location and because signs of vascular origin may not be clinically apparent, LMS of the GSV may be misinterpreted clinically as superficial nonvascular soft tissue mass. Herein, we report a case on the distal portion of the right GSV of a 57-year-old man. The histopathological recognition of a large-caliber vein-associated LMS (with granular cell change) in an incisional biopsy specimen was crucial to guide radiological evaluation and confirmation of a superficial vascular LMS before surgical treatment. Recognizing this entity in small biopsies is important as its surgical treatment and prognosis differ substantially from nonvascular superficial (ie, subcutaneous and dermal) LMSs. In addition, because vascular LMSs can involve long vessel segments, underestimation of extent of disease is a risk. To the best of our knowledge, granular cell change has not been documented in LMS of the GSV.

Metastasizing Malignant Granular Cell Tumor (Abrikossoff Tumor) of the Anterior Abdominal Wall, with Prolonged Survival

“…The granular cells in their cases stained negative for S100 protein, but positive for CD68. The spindle cell component of the tumor stained positive for smooth muscle actin [48]. Alveolar soft part sarcoma has a distinctive organoid pattern and lacks S100 protein positivity [46].…”

Great saphenous vein leiomyosarcoma mimicking thrombosed aneurysm: A case report and review of the literature

“…If the needle biopsy results are inconclusive, an incisional biopsy specimen will be necessary to guide the radiologic evaluation and confirm the presence of a superficial VLMS before surgical treatment. 19 An excisional biopsy can be performed for primary lesions <3 cm, with incisional biopsy used for larger masses >3 cm. 12 , 20 …”

Primary cutaneous vascular leiomyosarcoma: A rare subtype of leiomyosarcoma of the skin

“…We read with interest a recent JCP report on a vascular leiomyosarcoma arising from vena saphena magna. We report herein a case of primary cutaneous vascular leiomyosarcoma arising from a small‐caliber dermal vein.…”

“…In contrast to the deeply located vascular leiomyosarcoma, piloleiomyosarcoma tends to present in a more infiltrative growth pattern with ill‐defined borders. Vascular leiomyosarcoma arising from large‐caliber veins, such as the great saphenous vein, and others have been reported. In these cases, imaging findings in Doppler ultrasound, angio‐computed tomography (CT) scan, and/or arteriography suggested vascular involvement.…”