Solution to Case 2. Leiomyosarcoma of the inferior vena cava revealed by lower extremities edema

Commentation

In this patient, abdominal CT scan revealed a large retroperitoneal solid mass heterogeneously enhanced after contrast injection (Fig. 1). This mass was centered on the inferior under renal vena cava which was no more individualized. It had irregular borders and was associated with iliac veins thrombosis. It invaded the lumbar segment of right ureter. It invaded the right psoas muscle and was in contact with the spine. Onward, it came in contact with the third duodenum. The inferior vena cava above renal was permeable (Fig. 2).

Figure 1.

Abdominal CT scan, axial view: large retroperitoneal solid mass (white arrowheads), heterogeneously enhanced after contrast injection, with large contact with aorta and no visualization of the inferior vena cava.

Figure 2.

Abdominal CT scan, frontal view: heterogeneous mass (white star) centered on the inferior under renal vena cava causing iliac veins thrombosis (white arrows) which are no more filled with contrast. Above renal inferior vena cava (black arrows).

The patient underwent CT-guided needle core biopsy. Histological examination showed a malignant mesenchymal proliferation. An immunohistochemical study was performed. Morphological and immunohistochemical features were consistent with leiomyosarcoma^1,2.

Answer to question: b.

Diagnosis: Histológico (biopsia guiada por TC): Leiomiosarcoma.