PMC9019075_01
Abdominal ultrasonography images in the epigastric sagittal view: a hypoechoic, irregularly shaped solid mass was seen adjacent to the IVC.
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F1
Ultrasound of the abdomen showed a retroperitoneal tumor measuring 4.8 x 2.3 cm (Figure 1).
Preoperative contrast-enhanced CT images. The border between the tumor and IVC was indistinct.
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F2
Abdominal contrast enhanced computed tomography (CT) revealed a retroperitoneal mass 34 mm x 27 mm in size, near right renal veins extending to inferior vena cava, and it was pushing the pancreas forward (Figure 2). Abdominal contrast enhanced CT did not reveal any evidence of retroperitoneal enlarged lymph nodes. The border between the tumor and IVC was indistinct at the arterial phase, the venous phase and the delayed phase (Figure 2).
Preoperative contrast-enhanced CT images revealed a ball-shaped mass with heterogeneous enhancement in the left lung lobe.
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F3
The CT scan of the chest showed a tumor in the lingual segment of the upper lobe of the left lung, consisting of ground-glass nodules with unclear boundaries; The tumor was approximately 1.3 cm x 1.1 cm in size and multiple short burls can be seen around the edges of the tumor. There were no enlarged lymph nodes in the mediastinum (Figure 3).
Image showing spindle-shaped tumor cells with areas of hypercellularity that were arranged in fascicles, bundles and interlacing patterns.
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F4
The histopathological examination showed a well-circumscribed mass composed of spindle cells arranged in interlaced and bundles (Figure 4). The nucleus is deeply stained, the end is blunt, located in the center, with a certain degree of heteromorphism and pleomorphism (Figure 4).
The histopathological examination of the excised mass combined with the pathology expert group discussion considered lung adenocarcinoma.
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F5
The histopathological examination of the excised mass showed lung adenocarcinoma (Figure 5).
Contrast-enhanced CT images at 18 months after second surgery: lump in upper lobe of the right lung.
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F6
Follow-up based on patient's recent medical history, chest and abdominal physical examination, complete blood count, liver function tests, tumor markers monitoring, ultrasound scan of the abdomen every 3 months, CT scans of the lung, abdomen and head every 6 months. 20 months after resection of inferior vena cava leiomyosarcoma, the contrast-enhanced CT images show two lump about 1.2 and 0.7 cm in diameter in upper lobe (Figure 6) and lower lobe of the right lung (Figure 7).
Contrast-enhanced CT images at 18 months after second surgery: lump in lower lobe of the right lung.
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F7
Follow-up based on patient's recent medical history, chest and abdominal physical examination, complete blood count, liver function tests, tumor markers monitoring, ultrasound scan of the abdomen every 3 months, CT scans of the lung, abdomen and head every 6 months. 20 months after resection of inferior vena cava leiomyosarcoma, the contrast-enhanced CT images show two lump about 1.2 and 0.7 cm in diameter in upper lobe (Figure 6) and lower lobe of the right lung (Figure 7).
The metastasis of inferior vena cava sarcoma in lung.
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F8
The immunohistochemical results of postoperative specimens were consistent with the metastasis of inferior vena cava leiomyosarcoma (Figure 8).
Historical and current information from this case organized as a timeline.
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F9
During on-going regular follow-up visits no evidence of recurrence or metastasis was observed from December 2020 to October 2021 (Figure 9).