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Lenny S Krishna K K Izan M G Azim I H Harunarashid

Abstract

INTRODUCTION


Inferior Vena Cava (IVC) leiomyosarcoma is a very rare vascular tumour. It is a slow growing tumour, a fact that frequently delays the diagnosis and keeps the patient to be asymptomatic.


CASE REPORT


Case 1 50 year old gentleman was incidentally found to have a large mass in the abdomen via ultrasound while he was being investigated fo anaemia. Computerised tomography (CT) scan revealed a retroperitoneal tumour which was arising from the inferior vena cava. The tumour was resected en bloc and the inferior vena cava was repaired with a vein patch. No notable post operative complication. Histopathology examination shows grade I leiomyosarcoma of the inferior vena cava. The margin was clear. Patient was sent for chemotherapy. During follow-up, there was no evidence of recurrence.


Case 2 61 year old lady presented with right hypochondrium pain and bilateral lower limb swelling. Abdominal examination was unremarkable. Both lower limbs are oedematous. Ultrasonography of the abdomen shows multiple liver cysts with biliary duct dilatation. Subsequent Computerised tomography abdomen revealed long segment occlusive thrombosis of infrahepatic inferior vena cava. No other suspicious lesion in other organs. Gastroscopy and colonoscopy was normal. PET scan showed a metabolically active intraluminal mass within infrahepatic inferior vena cava. Tumour markers were within normal limit. She developed bilateral femoral vein complete occlusion with left long saphenous vein thrombosis. Inferior vena cava filter insertion was done. Laparotomy showed inferior vena cava mass 7x7x6 cm in size and thrombosed bilateral renal vein. Resection of the mass and graft reconstruction were done for the Inferior vena cava and the bilateral renal veins. The histopathology examination shows leiomyosarcoma. She was sent for chemotherapy. Post operatively, she developed chyle leak, successfully managed conservatively.


CONCLUSION


Leiomyosarcomas are the most common malignancy involving the IVC. Although there are correlations between clinical manifestations and the location of the tumour within the IVC, most patients present with non specific symptoms. Aggressive surgical treatment is recommended due to the tumour’s slow growth pattern and low metastatic potential, though chemoradiotherapy may serve as an adjunct. 

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