Pulmonary Embolism Caused by Intravenous Leiomyosarcoma of the Lower Limb

Kado, Soichiro; Goto, Masahide; Yamao, Hidetsugu; Tsukada, Toru; Satô, Masataka; Uekusa, Yoshifumi

doi:10.2169/internalmedicine.0030-17

Cited by 4 publications

(4 citation statements)

References 10 publications

(11 reference statements)

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“…Although vascular LMS is rare, accounting for less than 2% of all LMSs, limited case reports do exist [ 13 – 16 ]. Most vascular LMS cases are located in the iliac vein, as was observed in our patient [ 17 ]. LMS of pulmonary vascular origin was also considered in the differential diagnosis; however, only two such cases have been reported in the literature [ 17 – 19 ].…”

Section: Discussionsupporting

confidence: 60%

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Venous Thromboembolism in Metastatic Uterine Leiomyosarcoma: A Case Report and Review of the Literature

Swisher,

Ornelas,

Ornelas

et al. 2023

Case Rep Oncol

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We report an unusual case of extensive deep vein thrombosis (DVT) and pulmonary embolism (PE) in the setting of metastatic uterine leiomyosarcoma. Recognition of the associated sequelae of this condition may improve short- and long-term outcomes. A 56-year-old black female with a history of uterine leiomyosarcoma diagnosed incidentally after total abdominal hysterectomy for fibroid uterus without initiation of chemoradiation treatment presented to the emergency department complaining of generalized weakness and progressively worsening stridor for 2 weeks. The patient was experiencing shortness of breath, dysphagia, and hoarseness. Physical exam was remarkable for rhonchi but was otherwise normal. Diagnostic imaging via CT of the abdomen, pelvis, and chest revealed DVTs of the left common and external iliac veins, the superior mesenteric artery, multiple pulmonary emboli of the right pulmonary artery, several nodular lesions within the lungs, and scattered peritoneal necrotic lesions, which were suspicious for metastatic disease. Additionally, CT of the neck showed an exophytic mass protruding into the airway from the subglottic region and thyromegaly with bilateral thyroid lobe nodules. The patient was subsequently started on Eliquis and chemotherapy. The rarity of this case is rooted in the extent of the patient’s DVTs and PEs secondary to hypercoagulability in metastatic cancer. This presentation should be further evaluated to exclude thrombophilias or underlying malignancies. Drawing from the lessons of this case will help guide future clinical management regarding the care of metastatic uterine leiomyosarcoma.

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Section: Discussionsupporting

confidence: 60%

“…Most vascular LMS cases are located in the iliac vein, as was observed in our patient [17]. LMS of pulmonary vascular origin was also considered in the differential diagnosis; however, only two such cases have been reported in the literature [17‒19].…”

Section: Discussionmentioning

confidence: 72%

Venous Thromboembolism in Metastatic Uterine Leiomyosarcoma: A Case Report and Review of the Literature

Swisher,

Ornelas,

Ornelas

et al. 2023

Case Rep Oncol

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“…Tumor emboli occur when there is intravenous invasion by a benign or malignant tumor. Most commonly associated with renal, breast, lung, or gastric cancers, tumor emboli from leiomyosarcoma are extremely rare, with only a few case reports worldwide [6]. Further, we have found no case reports of leiomyosarcoma tumor emboli incidentally discovered in an asymptomatic patient.…”

Section: Introductionmentioning

confidence: 62%

“…In this case, the mass was detected incidentally before it could progress and cause circulatory compromise. Most patients with tumor emboli present with symptoms similar to those with venous thromboembolism such as dyspnea and hypoxia [1][2][3][4][5][6]. Further, it is well established that active malignancy increases the risk for thrombosis, which may bias physicians towards a diagnosis of venous thromboembolism [7].…”

Section: Discussionmentioning

confidence: 99%

Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit

et al. 2020

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Objective:Rare disease Background:Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as "thrombus in transit." Case Report:The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as "thrombus in transit", this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma. Conclusions:With rare exceptions, "thrombus in transit" is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radiographic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism.

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