PMC9949943_01
Physical examination findings. (a) Posterior view. (b) Oblique view.
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It was 10 x 10 cm in size, movable, and mildly tender (Figures 1(a) and 1(b)).
Magnetic resonance imaging. (a) Sagittal view with gadolinium contrast. (b) Axial view with gadolinium contrast. (c) Axial T2-weighted image.
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Magnetic resonance imaging (MRI) showed a deep-seated heterogeneous soft tissue mass originating from the popliteal vein (Figures 2(a), 2(b), and 2(c)).
There is positive immunoreactivity for (a) desmin, (b) smooth muscle actin, and (c) caldesmon, which supports the diagnosis of leiomyosarcoma.
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The pathological report indicated a malignant soft tissue tumor that was immunohistochemically positive for smooth muscle actin, epithelial membrane antigen, vimentin, caldesmon, and desmin, compatible with LMS (Figures 3(a), 3(b), and 3(c)).
Tumor removal. (a) Incision. (b) Tumor after en bloc excision (superficial view). (c) Tumor after en bloc excision (deep margin). (d) Popliteal vein involved by tumor. (e) Surgical wound covered by split-thickness skin graft.
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Gross specimens. (a) Posterior part. (b) Anterior part. (c) Medial section (saggital plane). (d) Superior section (transverse plane).
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The final pathology report from the surgical specimen revealed a typical intersecting 90-degree angle fascicular arrangement of spindle cells as well as scattered pleomorphic hyperchromatic cells with typical cigar-shaped nuclei and eosinophilic cytoplasm, compatible with LMS (Figures 5(a), 5(b), 5(c), and 5(d)).
(a) Low power magnification of leiomyosarcoma reveals typically intersecting 90-degree angle fascicular arrangement of spindle cells. (b) High magnification area shows scattered pleomorphic hyperchromatic cells with typically "cigar-shaped" nuclei (arrowhead) and eosinophilic cytoplasm. (c) and (d) Reveals increase mitotic activity with atypical forms. (e) and (f) Sections from the main vessel show the neoplasm derived from the tunica media of the vessel (arrowhead) and high magnification reveals significantly cytologic atypia.
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Clinical result at the 16-month follow-up. (a) Good healing of the surgical wound was attained without tumor recurrence. (b) Full range of motion of the involved knee was attained.
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fig7
The patient had good functional outcomes (Figures 7(a) and 7(b)).