Delayed diagnosis of leiomyosarcoma of the common femoral artery after endovascular repair

Femoral Artery Leiomyosarcoma: Case Report and Literature Review

BACKGROUND

Vascular leiomyosarcoma is a rare type of malignant tumor which arises from the smooth muscle tissue of blood vessel walls; it involves veins five times more frequently than arteries. There are only a few cases published in the literature and consequently there is limited experience regarding treatment and prognosis.

METHODS

A 66-year-old woman presented with left lower limb swelling and a left inguinal mass. Imaging revealed a seven-by-five cm well-circumscribed oval inguinal mass that incorporated the common femoral artery including its bifurcation and compressed the common femoral vein. Other malignancies or metastatic disease were excluded. The patient underwent en bloc resection of the tumor, including the common femoral artery and its bifurcation and arterial reconstruction, using the inverted contralateral great saphenous vein, was carried out. Histopathological examination of the mass revealed moderately-differentiated leiomyosarcoma arising from the femoral artery wall without invasion of the intima. The postoperative course was uneventful. 12 months after the procedure the patient was in good clinical conditions and a contrast enhanced CT scan showed patency of the arterial reconstruction without local recurrence or metastatic disease.

RESULTS

A systematic literature search identified nine cases of femoral artery leiomyosarcoma; in the eight patients for whom follow-up data were reported, recurrent or metastatic disease developed in five and only three were alive and free of disease.

CONCLUSIONS

As with any soft tissues sarcoma, complete surgical resection is the cornerstone of treatment and any directly involved adjacent structures must be sacrificed, as well as a margin of uninvolved normal tissue; consequently, a vascular reconstruction is almost always necessary.

A case of leiomyosarcoma of the common femoral artery

Leiomyosarcomas are rare malignant tumors of smooth muscle cell origin with those originating from blood vessels accounting for <1%. We report the unusual case of a leiomyosarcoma originating in the wall of the common femoral artery, highlighting the management decisions for vascular tumors and providing a brief literature review for these unusual malignancies.

A case of intravascular epithelioid hemangioendothelioma occurring 14 years after coil embolization for an extracranial internal carotid artery aneurysm

Epithelioid hemangioendothelioma (EHE) is a rare neoplasm originating from various organs. The clinical outcome mostly depends on surgical resectability. The authors report an EHE of the extracranial internal carotid artery developed in a 59-year-old male patient 14 years after the intravascular coil embolization for a carotid aneurysm at the same site. Because the lesion was initially diagnosed as regrowth of the thrombosed aneurysm, decision for radical resection was delayed, and the patient died from rapid tumor progression. Differential diagnosis of atypical vascular mass lesions should include neoplasm, because initial radical resection may be the key to achieve a better prognosis.