PMC9499726_01
(A) and (B) Computed tomography angiography of the abdomen and pelvis in axial and coronal views, respectively; (C) Axial magnetic resonance in T2. Red arrows indicate the inferior vena cava leiomyosarcoma.
jvb-21-e20210129-g01-en.jpg
PMC9499726_01_jvb-21-e20210129-g01-en.jpg
gf0100
The cranial portion was completely intraluminal and at the level at which the renal veins drain to the IVC, while the caudal portion was extraluminal and extended to the level of the aortic bifurcation, which was suggestive of a leiomyosarcoma of the IVC (Figure 1).
(A) Leiomyosarcoma of the inferior vena cava after dissection; (B) Reconstruction of the inferior vena cava with interposition of a Dacron graft; final result.
jvb-21-e20210129-g02-en.jpg
PMC9499726_01_jvb-21-e20210129-g02-en.jpg
gf0200
The team proceeded to dissection, removing the retroperitoneal tumor en bloc by complete circumferential resection of the IVC section containing it and then reconstructed the IVC by interposition of a 24 mm tubular prosthetic Dacron graft, with proximal anastomosis, including the renal vein and proximal IVC, and distal anastomosis, including the distal IVC (Figure 2).
Surgical specimen after resection en bloc.
jvb-21-e20210129-g03-en.jpg
PMC9499726_01_jvb-21-e20210129-g03-en.jpg
gf0300
Anatomopathological examination of the specimen (Figure 3) revealed a mesenchymal spindle cell tumor with free margins, while immunohistochemistry confirmed a diagnosis of high grade leiomyosarcoma of the IVC.
Coronal computed tomography angiography of the abdomen and pelvis in the fifth postoperative month. Red arrow indicates the Dacron graft; white arrow indicates the distal anastomosis with the inferior vena cava.
jvb-21-e20210129-g04-en.jpg
PMC9499726_01_jvb-21-e20210129-g04-en.jpg
gf0400
The patient was discharged from the vascular surgery outpatients clinic after 5 months of follow-up, asymptomatic and with imaging exam within normal limits (Figure 4).