1
|
Atieh A, Allaw H, Ashouri M, Zafarghandi M. Great saphenous vein leiomyosarcoma mimicking thrombosed aneurysm: A case report and review of the literature. J Vasc Surg Cases Innov Tech 2024; 10:101399. [PMID: 38304299 PMCID: PMC10830851 DOI: 10.1016/j.jvscit.2023.101399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024] Open
Abstract
Vascular leiomyosarcoma LMS. is an extremely rare subgroup of LMSs. Fewer than 50 cases of LMS originating from the great saphenous vein have been reported. In 43% of reported cases, LMS was misdiagnosed clinically. In our case, the patient was initially misdiagnosed as having a thrombosed aneurysm. This misdiagnosis could be due to the rarity of great saphenous vein LMS cases, for which a high index of suspicion is needed, and because no specific radiologic findings have been established for diagnosing LMSs. Masses presenting along the course of vessels should be suspected for malignancy, which can be helpful in performing definitive surgery and avoiding multiple surgeries.
Collapse
Affiliation(s)
- Ammar Atieh
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Hussein Allaw
- Department of Radiology, Namazi Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Ashouri
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammadreza Zafarghandi
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
2
|
Angelini A, Biz C, Cerchiaro M, Longhi V, Ruggieri P. Malignant Bone and Soft Tissue Lesions of the Foot. J Clin Med 2023; 12:3038. [PMID: 37109375 PMCID: PMC10146676 DOI: 10.3390/jcm12083038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed by a properly performed biopsy, is thus mandatory to avoid these pitfalls. The present article reviews the most common malignant bone and soft tissue lesions of the foot region, discussing their clinicopathological presentation, imaging features, and current concepts in treatment.
Collapse
Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy (P.R.)
| | | | | | | | | |
Collapse
|
3
|
Tresgallo-Parés R, De Virgilio-Salgado L, Torres-Lugo NJ, Asenjo-Molina NA, Ramirez N, Bibiloni-Rodríguez J. Primary leiomyosarcoma of the great saphenous vein: A case report. Int J Surg Case Rep 2021; 88:106565. [PMID: 34741863 PMCID: PMC8581499 DOI: 10.1016/j.ijscr.2021.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/14/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Vascular smooth muscle sarcomas are rare neoplasms that comprise less than 2% of all leiomyosarcomas. These malignancies usually originate in the inferior vena cava, with a limited number of cases affecting the great saphenous vein. Due to the limited reports on these sarcomas, epidemiologic data remains insufficient. Case presentation We report the case of a 67-year-old Hispanic female that presented with an asymptomatic growing mass in her right thigh. She was managed with an En bloc resection under the impression of a smooth muscle vascular sarcoma. The diagnosis was confirmed after histopathologic evaluation. Clinical discussion Vascular leiomyosarcomas remain a rare and challenging diagnosis. They usually present as a slowly growing mass that is initially asymptomatic. High clinical suspicion and a comprehensive radiologic evaluation, including magnetic resonance imaging, are crucial. Histopathological evaluation is essential for diagnostic confirmation. Surgical excision remains the treatment of choice, with radiation therapy mostly considered for local disease control. Postsurgical surveillance is necessary every three months to monitor for signs of recurrence. Conclusion Physicians should remain aware of the nonspecific presentation of leiomyosarcomas and the importance of a comprehensive diagnostic approach. Early diagnosis and adequate management are fundamental elements in the treatment of these aggressive tumors. Consider leiomyosarcoma within the differential diagnosis of a painless enlarging mass. Doppler ultrasound and magnetic resonance imaging are valuable diagnostic tools. Data support radiation therapy for local control of these neoplasms. This case contributes to the limited literature regarding the epidemiology and treatment of these tumors.
Collapse
Affiliation(s)
- Ruben Tresgallo-Parés
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067
| | - Lucas De Virgilio-Salgado
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067.
| | - Norberto J Torres-Lugo
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067.
| | - Natalia A Asenjo-Molina
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan Puerto Rico 00936-5067.
| | - Norman Ramirez
- Department of Pediatric Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico 00680
| | - Juan Bibiloni-Rodríguez
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067
| |
Collapse
|
4
|
Scaglioni MF, Meroni M, Fritsche E, Fuchs B. Combined double superficial circumflex iliac artery perforator flap with lymphatic tissue preservation and lymphovenous anastomosis for lymphatic sequelae prevention in thigh defect reconstruction: A case report. Microsurgery 2021; 42:265-270. [PMID: 33580739 DOI: 10.1002/micr.30723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 02/05/2021] [Indexed: 11/05/2022]
Abstract
The thigh region is often site of soft tissue tumors development. Leiomyosarcoma, in particular, is a malignant tumor that, if not promptly treated, presents a growth rate that often results in large masses. The safest treatment in these cases is margin-free extensive surgical resection. This leads to rather large defects that in a delicate region, such as the medial thigh, implies a series of possible complications from the lymphatic point of view. In this region run major lymphatic vessels, appointed to drain the whole leg. Now that one is aware of this issue, the best solution is trying to obtain an efficient reconstruction and preventing the development of postoperative lymphedema and lymphocele. Here, we present a case of great saphenous vein leiomyosarcoma resection in the right medial thigh reconstructed by means of two superficial circumflex iliac artery perforator (SCIP) flaps with lymphatic tissue preservation, combined with preventive lymphovenous anastomosis (LVA). A 67-years-old woman presented a 22 × 16 cm soft tissue defect after the surgical excision. To fill the defect, we resorted to a larger SCIP flap island, supplied by both the superficial and deep branches of the superficial circumflex iliac artery anastomosed in perforator-to-perforator fashion, and to a smaller SCIP flap island supplied only by the superficial branch. Before surgery, the lymphatic vessels running in the flaps area were identified with indocyanine green lymphography and were carefully preserved during the harvest procedure. They were then transferred with the surrounding tissue and orientated in order to match the lymphatic flow direction, providing further fluid drainage. To boost the lymphatic drainage, an LVA was also performed at the superior-edge-of-the-knee incision point joining a functioning lymphatic vessel to a nearby reflux-free vein. The postoperative course was uneventful and at 7 months follow-up, the patient showed good cosmetic and functional outcomes with no swelling and no signs of tumor relapse. This report provides a series of technical insights and adds further evidence to support the efficacy of this procedure for management of soft tissue defects in the medial thigh region.
Collapse
Affiliation(s)
- Mario F Scaglioni
- Depatment of Hand and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Depatment of Hand and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Elmar Fritsche
- Depatment of Hand and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Orthopedic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| |
Collapse
|
5
|
Voskanyan SE, Shabalin MV, Artemyev AI, Kolyshev IY, Bashkov AN. [Recurrent hemangioendothelioma of the lower and middle segments of inferior vena cava with spread to previously installed prosthesis]. Khirurgiia (Mosk) 2020:65-69. [PMID: 32352671 DOI: 10.17116/hirurgia202004165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report surgical treatment of a 65-year-old patient with recurrent hemangioendothelioma of inferior and middle segment of inferior vena cava with spread to previously established prosthesis. Advanced resection of inferior vena cava and right-sided nephrectomy were not followed by complications and resulted R0 resection. Surgery time was 180 min. Inferior vena cava cross-clamping time was 30 min. Total blood loss was 300 ml. Hemangioendothelioma is a rare tumor with unpredictable potential for malignant transformation and obligatory indications for surgical treatment. Resection and reconstruction of inferior vena cava and renal veins with a synthetic conduit is effective and safe procedure.
Collapse
Affiliation(s)
- S E Voskanyan
- Burnazyan Federal Medical Biophysical Center of FMBA, Moscow, Russia
| | - M V Shabalin
- Burnazyan Federal Medical Biophysical Center of FMBA, Moscow, Russia
| | - A I Artemyev
- Burnazyan Federal Medical Biophysical Center of FMBA, Moscow, Russia
| | - I Yu Kolyshev
- Burnazyan Federal Medical Biophysical Center of FMBA, Moscow, Russia
| | - A N Bashkov
- Burnazyan Federal Medical Biophysical Center of FMBA, Moscow, Russia
| |
Collapse
|
6
|
Naouli H, Lathelize H, Bouarhroum A. Leiomyosarcoma of the Great Saphenous Vein: Case Report and Literature Review. Ann Vasc Surg 2019; 56:353.e1-353.e6. [DOI: 10.1016/j.avsg.2018.08.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 10/27/2022]
|
7
|
Recurrence of Primary Vascular Leiomyosarcoma Five Years after Initial Diagnosis in the Lower Extremity. Case Rep Oncol Med 2018; 2018:3094616. [PMID: 29971175 PMCID: PMC6008775 DOI: 10.1155/2018/3094616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022] Open
Abstract
Primary leiomyosarcomas of vascular origin are rare tumors. They frequently arise within the inferior vena cava; however, the peripheral vein was also affected. To date, only a few hundred cases have been reported in the world literature. Although it is an extremely aggressive tumor, the symptoms may be unspecific, especially in the lower extremities. In this report, we present a case of primary vascular leiomyosarcoma, arising from the short saphenous vein, with symptoms mimicking thrombus in the initial diagnosis. The diagnosis of leiomyosarcomas was confirmed by standard H&E staining and immunohistochemical staining. Recurrence of the tumor has been observed five years after surgical treatment. Due to its rarity, experience in the management of this type of tumor is limited. The mainstay of treatment for these tumors is complete surgical resection. The purpose of the presented case is to discuss the clinicopathological features and management options of this tumor, under the light of the most recent literatures.
Collapse
|
8
|
Macarenco RS, Filippi RZ, D'Almeida Costa F, Jesus-Garcia R. Leiomyosarcoma of the great saphenous vein (vena saphena magna) with granular cell change: Report of a superficial neoplasm. J Cutan Pathol 2017; 45:141-145. [PMID: 29068077 DOI: 10.1111/cup.13062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 10/08/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
The great saphenous vein (GSV) corresponds to the main superficial large-caliber vessel affected by leiomyosarcoma (LMS). Given its superficial location and because signs of vascular origin may not be clinically apparent, LMS of the GSV may be misinterpreted clinically as superficial nonvascular soft tissue mass. Herein, we report a case on the distal portion of the right GSV of a 57-year-old man. The histopathological recognition of a large-caliber vein-associated LMS (with granular cell change) in an incisional biopsy specimen was crucial to guide radiological evaluation and confirmation of a superficial vascular LMS before surgical treatment. Recognizing this entity in small biopsies is important as its surgical treatment and prognosis differ substantially from nonvascular superficial (ie, subcutaneous and dermal) LMSs. In addition, because vascular LMSs can involve long vessel segments, underestimation of extent of disease is a risk. To the best of our knowledge, granular cell change has not been documented in LMS of the GSV.
Collapse
Affiliation(s)
- Ricardo S Macarenco
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Renee Z Filippi
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Reynaldo Jesus-Garcia
- Orthopedic Oncology Department, Hospital Israelita Albert Einstein, Centro de Oncologia e Hematologia Família Dayan Daycoval, São Paulo, Brazil
| |
Collapse
|
9
|
Cangiano R, Orlandino G, Patitucci G, Lembo F, Fabrizio T. Primary Leiomyosarcoma of the Great Saphenous Vein: Case Report and Review of the Literature. Ann Vasc Surg 2017; 38:315.e1-315.e7. [DOI: 10.1016/j.avsg.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
|
10
|
Lin WW, Erkan S, Smith RC, Sieunarine K. Leiomyosarcoma of great saphenous vein localised to the calf. BMJ Case Rep 2016; 2016:bcr-2016-215829. [PMID: 27797794 DOI: 10.1136/bcr-2016-215829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 76-year-old man with a 2-month history of mildly tender swelling in the right calf for which he had an initial excision and then a wide local excision followed by a split skin graft because the initial histopathology confirmed that there was a Grade I leiomyosarcoma of great saphenous vein. A simple lump in the lower limb could be a malignant vascular tumour and should always be considered in the list of differential diagnosis of a lump in the lower limb.
Collapse
Affiliation(s)
- Wah Wah Lin
- Department of Vascular Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Serkan Erkan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Richard Carey Smith
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | | |
Collapse
|
11
|
Amato ACM, Silva AJDD, Santos RVD, Amato SJDTA. Leiomyosarcoma of the great saphenous vein. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 56-year-old male patient presented with a complaint of two painful, hard, palpable nodules in the right lower limb. A Doppler ultrasound scan revealed the presence of nodules, likely to be neoplastic. Computed angiography showed two solid hypervascular nodules in the right great saphenous vein, fed by branches of the posterior tibial artery. Embolization of the nodules using surgical cyanoacrylate was performed, followed by an excisional biopsy. Anatomical pathology and immunohistochemical analysis identified the nodule as a high-grade leiomyosarcoma, characterized by ten mitotic figures per ten high-power fields, necrosis and cell pleomorphism. Immunohistochemical analysis results were positive for caldesmon and desmin labeling. A second surgical procedure was performed to enlarge the free margins.
Collapse
|
12
|
Fremed DI, Faries PL, Schanzer HR, Marin ML, Ting W. Primary leiomyosarcoma of saphenous vein presenting as deep venous thrombosis. Vascular 2013; 22:450-3. [DOI: 10.1177/1708538113516446] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Only a small number of venous leiomyosarcomas have been previously reported. Of these tumors, those of saphenous origin comprise a minority of cases. A 59-year-old man presented with symptoms of deep vein thrombosis and was eventually diagnosed with primary leiomyosarcoma of great saphenous vein origin. The tumor was treated with primary resection and femoral vein reconstruction with autologous patch. Although extremely rare, saphenous leiomyosarcoma can present as deep vein thrombosis. Vascular tumors should be included in the differential diagnosis of atypical extremity swelling refractory to conventional deep vein thrombosis management.
Collapse
Affiliation(s)
- Daniel I Fremed
- Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY, USA
| | - Peter L Faries
- Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY, USA
| | - Harry R Schanzer
- Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY, USA
| | - Michael L Marin
- Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY, USA
| |
Collapse
|