Vol.2, No.6, 335-337 (2013) Case Reports in Clinical Medicine
http://dx.doi.org/10.4236/crcm.2013.26090
Curative resection of leiomyosarcoma with resection
and reconstruction of inferior vena cava
Yashiro Motooka1, Daisuke Hashimoto1, Hisashi Sakaguchi2, Akira Chikamoto1, Toru Beppu1,
Michio Kawasuji2, Hideo Baba1*
1Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan;
*Corresponding Author: hdobaba@kumamoto-u.ac.jp
2Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
Received 7 June 2013; revised 8 July 2013; accepted 20 July 2013
Copyright © 2013 Yashiro Motooka et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Leiomyosarcoma of the inferior vena cava (IVC)
is a rare tumor, and it needs complete surgical
resection for cure. In addition, the reconstruc-
tion of IVC is necessary in many cases. Herein,
we indicate the case of a 57-year-old female with
leiomyosarcoma in segment I of the IVC, which
grew deep into vascular lumen. She underwent
complete en bloc resection of the tumor and IVC
reconstruction by an artificial pericardium p atch.
Keywords: Leiomyosarcoma; Inferior Vena Cava;
Reconstruct
1. INTRODUCTION
Leiomyosarcoma is a rare malignant tumor of smooth
muscle cell, and rarely develops from inferior vena cava
(IVC) with intraluminal and/or extraluminal growth [1-6].
Because the long-term survival is not favorable (5-year
survival 38%, 10-year survival 14%) [7], curative en
bloc resection with IVC and reconstruction of that is
important to cure. The location of leiomyosarcoma of the
IVC is divided into three levels: segment I, lower level
(IVC below the renal veins); segment II, middle level
(renal veins to hepatic veins, most frequently affected);
and segment III, upper level (entry of hepatic veins to the
right atrium) [8].
In this report, we indicate the case of a 57-year-old
female with leiomyosarcoma in segment I of the IVC.
She underwent complete en bloc resection of the tumor
and IVC reconstruction.
2. CASE REPORT
A 57-year-old female with no complaint received health
screening abdominal ultrasound, which found retroperi-
toneal tumor. Enhanced computed tomography (CT) scan
revealed a tumor (diameter: 2.5 cm) on the right side of
IVC with growth into the IVC (Figures 1(A) and (B)).
Maximum standardized uptake value (SUV max) of the
tumor in positron emission tomography (PET)-CT was
4.4 5.3, and no distant metastasis was found.
Therefore, we planned a surgical resection with the
patient’s informed consent. Laparotomy showed that
30mm tumor existed on the right side wall of IVC below
the right renal vein junction (segment I), invading IVC
widely (Figure 2(A)). An incision was made onto the
clamped IVC, and it showed that the tumor protruded
into the cavity of IVC. The tumor was resected en-block
with IVC. Deficient hole of IVC was 2.5 × 2.3 cm (Fig-
ure 2(B)), and reconstructed by GORE-TEX® Cardio-
vascular Patch (W. L. Gore & Associates, Inc. Flagstaff,
Figure 1. Preoperative findings. Enhanced CT revealed a tumor
(arrowheads) on the right side of IVC with growth into the IVC
((A), (B)). SUV max of the tumor (arrowheads) in positron
emission tomography (PET)-CT was 4.4 5.3 (C).
Copyright © 2013 SciRes. Openly accessible at http://www.sc irp.or g/journal/crcm/
Y. Motooka et al. / Case Reports in Clinical Medicine 2 (2013) 335-337
336
AZ) with 6-0 polypropylene non-absorbable monofila-
ment suturing (Figure 2(C)). Macroscopically, the tumor
was elastic hard and the size was 5 × 2.5 × 2 cm (Figure
3(A)). Postoperative pathological diagnosis was leiomy-
osarcoma (Figure 3(B)). No sign of recurrence was ob-
Figure 2. Surgical findings. Laparotomy show-
ed that a tumor (arrowheads) existed on the
right side wall of IVC below the right renal
vein junction (segment I), invading IVC wide-
ly (A). Deficient hole (arrowheads) of IVC
after en-block resection of the tumor was 2.5
× 2.3 cm (B). Reconstructed by GORE-TEX®
Cardiovascular Patch (arrowheads) was per-
formed (C).
Figure 3. Pathological findings. Mac-
roscopically, the tumor was elastic hard
and the size was 5 × 2.5 × 2 cm (A)
(arrowheads; resected IVC). HE stain-
ing showed cellular eosinophilic spin-
dle cell tumor with nuclear atypia and
mitosis, then pathological diagnosis
was leiomyosarcoma (B).
served and the patency of IVC was retained completely
10 months after the operation.
3. DISCUSSION
Aggressive curative en bloc surgical treatment to
achieve extirpation of primary caval neoplasms or large
abdominal tumors with caval involvement may prolong
survival in selected patients [1-5]. Whereas a complete
resection of the IVC is necessary in most cases, man-
agement of IVC after tumor resection is still controver-
sial [8]. IVC reconstruction is performed by such as pri-
mary ligation, cavoplasty or graft replacement [9].
Kieffer et al. indicated that simple ligation is possible
after complete or subtotal resection of the infra-renal
IVC (segment I) with the assumption that slow tumor
growth allows sufficient collaterals developing [8]. How-
ever, in cases without enough sufficient collateral grow-
ing, simple ligation can make low limb edema with sig-
nificant functional impairment [9]. Thanks to advances
in surgical techniques for venous reconstruction, pros-
thetic replacement of the IVC is now feasible whenever
considered necessary [8].
In this case, leiomyosarcoma invaded the IVC widely.
However, the IVC was not obstructed, and then collat-
erals were not developed. Aggressive curative en bloc
surgical resection with IVC and reconstruction with an
artificial patch were performed successfully and showed
the successful long-term outcome without tumor recur-
rence. The patency of IVC has been kept, without any
thrombosis.
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