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Leiomyosarcoma of the Inferior Vena Cava With Kidney Invasion

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ABSTRACT

Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors associated with poor prognosis, and surgical resection with the goal of obtaining negative margins is the gold standard for initial treatment. Tumor characteristics of both extraluminal extension into renal parenchyma and intraluminal extension of the subdiaphragmatic IVC are even less common. The prognosis of vascular leiomyosarcomas is determined by the location and the size of the tumor, as these factors determine the risk of local recurrence and metastasis. We present a case of a 30-year old female incidentally found to have a 14 cm right renal mass and IVC thrombus.

No MeSH data available.


Related in: MedlinePlus

MRI abdomen and pelvis w/without IV contrast (T2 coronal image): 1. A 14 cm solid right renal mass with invasion of the inferior collecting system and extension into Gerota's fascia. Right renal vein and infra-diaphragmatic IVC tumor thrombus. 2. Inflammatory changes in left pelvis with a 7 x 6 cm complex fluid-filled para-ovarian cystic mass. 4.4 x 3.6 x 2.3 cm enhancing collection anterior to right ovary (not shown).
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fig1: MRI abdomen and pelvis w/without IV contrast (T2 coronal image): 1. A 14 cm solid right renal mass with invasion of the inferior collecting system and extension into Gerota's fascia. Right renal vein and infra-diaphragmatic IVC tumor thrombus. 2. Inflammatory changes in left pelvis with a 7 x 6 cm complex fluid-filled para-ovarian cystic mass. 4.4 x 3.6 x 2.3 cm enhancing collection anterior to right ovary (not shown).

Mentions: Further workup with an MRI confirmed the above findings and a level II IVC thrombus (Fig. 1). Further workup was negative for clinical metastasis. The patient underwent a right radical nephrectomy, IVC thrombus extraction and reconstruction, and left oophorectomy. A midline laparotomy was performed to obtain access to the IVC and kidney. A 6 cm incision was made to traverse the IVC in a cephalad direction at the right renal vein junction. The cava was cleared of thrombus and flushed with heparinized saline. Venoplasty was performed using 5-0 prolene suture. Immediately postoperatively in recovery room, a bilateral lower extremity Doppler ultrasound was obtained which was negative for deep vein thrombosis.


Leiomyosarcoma of the Inferior Vena Cava With Kidney Invasion
MRI abdomen and pelvis w/without IV contrast (T2 coronal image): 1. A 14 cm solid right renal mass with invasion of the inferior collecting system and extension into Gerota's fascia. Right renal vein and infra-diaphragmatic IVC tumor thrombus. 2. Inflammatory changes in left pelvis with a 7 x 6 cm complex fluid-filled para-ovarian cystic mass. 4.4 x 3.6 x 2.3 cm enhancing collection anterior to right ovary (not shown).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037210&req=5

fig1: MRI abdomen and pelvis w/without IV contrast (T2 coronal image): 1. A 14 cm solid right renal mass with invasion of the inferior collecting system and extension into Gerota's fascia. Right renal vein and infra-diaphragmatic IVC tumor thrombus. 2. Inflammatory changes in left pelvis with a 7 x 6 cm complex fluid-filled para-ovarian cystic mass. 4.4 x 3.6 x 2.3 cm enhancing collection anterior to right ovary (not shown).
Mentions: Further workup with an MRI confirmed the above findings and a level II IVC thrombus (Fig. 1). Further workup was negative for clinical metastasis. The patient underwent a right radical nephrectomy, IVC thrombus extraction and reconstruction, and left oophorectomy. A midline laparotomy was performed to obtain access to the IVC and kidney. A 6 cm incision was made to traverse the IVC in a cephalad direction at the right renal vein junction. The cava was cleared of thrombus and flushed with heparinized saline. Venoplasty was performed using 5-0 prolene suture. Immediately postoperatively in recovery room, a bilateral lower extremity Doppler ultrasound was obtained which was negative for deep vein thrombosis.

View Article: PubMed Central - PubMed

ABSTRACT

Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors associated with poor prognosis, and surgical resection with the goal of obtaining negative margins is the gold standard for initial treatment. Tumor characteristics of both extraluminal extension into renal parenchyma and intraluminal extension of the subdiaphragmatic IVC are even less common. The prognosis of vascular leiomyosarcomas is determined by the location and the size of the tumor, as these factors determine the risk of local recurrence and metastasis. We present a case of a 30-year old female incidentally found to have a 14 cm right renal mass and IVC thrombus.

No MeSH data available.


Related in: MedlinePlus