PMC10421572_01
Computed tomography image of the abdomen from the arterial phase, showing the tumor exerting mass effects on the liver and considerable reduction of the lumen of the retro-hepatic vena cava.
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Abdominal computed tomography (CT) showed an expansive mass located in the retroperitoneal space, in the infra-hepatic segment of the IVC, with considerable reduction of the lumen (Figure 1).
(a) Coronal magnetic resonance image in T2 showing the leiomyosarcoma exerting a mass effect on the area of the hepatic hilum and obstructing the inferior vena cava; (b) T2 axial image showing the lesion with regular outlines and well-defined limits, with low homogenous signal, and compressing the vena cava; (c) dual echo axial image showing the leiomyosarcoma in contact with segments I, V, and VI of the liver.
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Magnetic resonance showed that its dimensions were stable in relation to previous examinations (Figure 2).
View of the leiomyosarcoma after full mobilization of the liver and before clamping the vena cava above and below the tumor.
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Access was obtained via a transverse bilateral incision combined with a complete Kocher maneuver and extensive mobilization of the right lobe of the liver, exposing the entire extent of the abdominal cava, from the diaphragm to the renal veins (Figure 3).
Intraoperative image showing the inferior vena cava (arrow) and the leiomyosarcoma (on the left) before surgical resection.
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The tumor was visible in the retro-hepatic portion, obstructing the lumen of the vessel, but without invasion of the hepatic parenchyma or adjacent organs (Figure 4).
Exeresis of the inferior portion of the tumor and hemostasis with vascular staples (arrow).
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It was decided to resect the tumor in monobloc with the entire retro-hepatic portion of the vena cava (Figure 5).
The leiomyosarcoma after surgical resection.
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The postoperative anatomopathological examination revealed well-differentiated leiomyosarcoma, measuring 9.5 x 7.0 x 6.5 cm and weighing 281 g (Figure 6), with type 1 histological grade.
(a) Coronal magnetic resonance image in T2, 17 months after surgery, showing the sectioned segment of the inferior vena cava and absence of local relapse; (b) dual echo axial image showing the retro-hepatic region tumor free after surgery.
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Seventeen months after surgery, she was stable and free from local or remote relapses (Figure 7).