Title: Primary Leiomyosarcoma of the Inferior Vena Cava: is
vascular reconstruction always necessary?
Authors: Nizar Kardoun1, Ahmed
Bouzid1,&, Ayman Trigui 1, Haithem
Rejab1, BenAmar Mohamed1, Mzali
Rafik1
Affiliations: 1 General surgery Department,
Habib Bourguiba Hospital, Sfax, TN 3089
Corresponding Author: & General Surgery
Department Habib Bourguiba Hospital University of Sfax Route ElAin 0.5km
Sfax, TN 3021, Phone Number: 20679500
Abstract: Primary leimyosarcoma of the inferior vena cava is
considered as rare vascular retroperitoneal sarcoma. Although radical
resection with free margin is necessary, vascular strategies are very
challenging.
KEYWORDS: Primary leimyosarcoma, inferior vena cava, vascular
reconstruction
Key Clinical Message: The study of preoperative imaging is
essential for a better surgical strategy. The vascular reconstruction
depends essentially on the location and the size of the tumor best
evaluated intraoperatively.
A 65-year-old woman without past medical history presented with
intermittent right upper quadrant abdominal pain. The physical exam
revealed no characteristic features. Laboratory exam were normal.
Abdominal CT revealed a 6.5*5 cm heterogeneous non calcified soft-tissue
mass .This mass was invading the
inferior vena cava (IVC) and abutting to the right renal vein (figure
1). No focal other mass was observed in the abdominal cavity. Regarding
the high risk of malignancy, an exploratory laparotomy was performed.
During laparotomy, the tumor was adherent to the right lateral side of
IVC without evidence of endoluminal development (figure 2).
A radical en bloc resection of the tumor was performed with lateral
resection of the vena cava with primary closure.
Pathology confirmed R0 resection of a grade 1 primary leiomyosarcoma of
the inferior vena cave (PLV). Immunohistochemically, the tumor cells
were positive for PS-100 and desmin and negative for CK and c-kit.
PLV a rare retroperitoneal sarcomas originating from the smooth muscle
cells of the media with intra or extra-luminal growth1. Although vascular resection with free margin is
necessary, vascular reconstruction without graft interposition is not
always necessary. The vascular strategies depends essentially on the
location and the size of the tumor 2.
Author contribution statement: Nizar Kardoun: writing –review
and editing (equal); Ahmed Bouzid: Writing – review and editing
(equal); Ayman Trigui: review and editing; Haithem Rejab: Writing –
review and editing (equal); BenAmar Mohamed: Conceptualization, Mzali
Rafik: Validation- Supervision
References:
1. Dew J, Hansen K, Hammon J, McCoy T, Levine EA, Shen P. Leiomyosarcoma
of the Inferior Vena Cava: Surgical Management and Clinical Results.Am Surg . 2005;71(6):497-501. doi:10.1177/000313480507100609
2. Ruiz CS, Kalbaugh CA, Browder SE, et al. Operative strategies for
inferior vena cava repair in oncologic surgery. J Vasc Surg Venous
Lymphat Disord . 2020;8(3):396-404. doi:10.1016/j.jvsv.2019.09.012