Leiomyosarcoma of vascular origin: case report

Abstract

Leiomyosarcomas of vascular origin are uncommon. Originated from the smooth muscles of tunica media of major blood vessels leiomyosarcoma of venous origin is 5 times more common than those of arterial origin, 50% of cases originated in the lower vena cava. Most cases are presented in women with a median age of 50 years. We reported a 65-year-old woman, onset of symptoms 3 months before diagnosis with: pain, palpable tumor (9 cm × 5 cm), edema of the left lower extremity and unilateral intermittent claudication. CT with a vascularized mass, unrelated to adjacent muscle (tibialis posterior) of the left lower pelvic member, it displaces the path of the neurovascular bundle, with a probable origin in the posterior tibial vein. Total tumor resection was performed. Pathology reports a high-grade vascular leiomyosarcoma. T2a, Nx, Mx. Stage IIc. The diagnosis was confirmed by immunohistochemistry. The patient had adequate postoperative recovery without complications. Later the patient received 37 cycles of post-operatory radiotherapy. Currently (July 2015) the patient is asymptomatic. We present this case because although the frequency of this type of tumor is low, should be considered as a differential diagnosis in patients with mass, claudication and pain in lower pelvic member.

Recurrence Leiomyosarcoma of the Popliteal Vein: A Rare Soft Tissue Sarcoma

“…Vascular LMS is the least common subtype of LMS and originates from the tunica media of the vessel wall [ 1 ]. The popliteal vein is a very uncommon location of vascular LMS, and to the best of our knowledge, only nine cases have been reported to date [ 2 – 7 ].…”

“…About 510% of all soft tissue sarcomas are leiomyosarcoma (LMS). LMS is a soft tissue sarcoma that originates from smooth muscle cells, and it can be divided into three subtypes according to the site of presentation: soft tissue LMS, cutaneous LMS, and vascular LMS [ 1 ].…”

“…The first case of vascular LMS was reported by Perl in 1871, and the tumor originated from the inferior vena cava [ 2 – 4 ]. About one-third of vascular LMS is located in the extremities, most commonly in the saphenous vein (25%) [ 1 ]. Vascular LMS originating from the popliteal vein is very rare, and to the best of our knowledge, only nine cases have been reported to date [ 2 – 7 ].…”

“…A definitive diagnosis of vascular LMS is made by tissue biopsy and immunohistochemistry studies. The mainstay of treatment is en bloc resection of the tumor, including the involved segment of the vein, with a wide surgical margin [ 1 , 4 , 7 ]. Venous reconstruction after resection is not necessary in every case (especially in chronic cases with no history of an edematous leg) depending on the collateral venous circulation drainage [ 6 ].…”

“…Venous reconstruction after resection is not necessary in every case (especially in chronic cases with no history of an edematous leg) depending on the collateral venous circulation drainage [ 6 ]. Radiotherapy is an important adjuvant treatment for local control when the surgical margins are close or positive [ 1 , 7 ]. The role of chemotherapy for systemic control remains unclear.…”