PMC2630927_01
a, Magnetic resonance imaging shows the tumor (large asterisk) lying to the left of the superior mesenteric artery (SMA), involving the distal pancreas anteriorly, the superior pole of the left kidney posteriorly, and extending into the inferior vena cava (IVC) (small asterisk). b, The tumor (large asterisk) involves and encases the left renal vein and extends into the IVC. SMA indicates superior mesenteric artery.
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F1
Abdominal magnetic resonance imaging revealed a 15 x 6 x 5-cm, well-circumscribed, preaortic retroperitoneal mass, which involved the IVC, causing mass effect on the surrounding organs (Figure 1a, b).
The interposition polytetrafluoroethylene graft (asterisk) was anastomosed superiorly to the inferior vena cava (IVC) just below the liver, and inferior to the infrarenal IVC, the right renal vein (RRV) was reimplanted into the native IVC.
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F2
IVC reconstruction was performed from the level of the caudate lobe to the distal IVC in an end-to-end fashion with a 14-mm external ring-reinforced PTFE interposition graft (Figure 2).
a, Specimen contained tumor mass, left kidney, left adrenal gland, spleen, and distal pancreas. b, Leiomyosarcoma is seen in the lumen of the vena cava. The vena cava wall is on the right. c, Tumor fills the bottom of the picture pushing into the adrenal gland seen at the top of the picture. d, Tumor has replaced a portion of the pancreas. A pancreatic islet complex is marked (hematoxylin and eosin, original magnification x 20).
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F3
Gross and histopathologic examination revealed high-grade leiomyosarcoma originating from the IVC involving the adrenal gland and pancreas (Figure 3).
One-year follow-up magnetic resonance image shows patent polytetrafluoroethylene graft (asterisk) and no local tumor recurrence.
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F4
Follow-up abdominal imaging at 1 year revealed no recurrent abdominal disease and a patent IVC graft (Figure 4).