Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

Quan Wang,Mei-Shan Jin,Xueyuan Cao,Jing Jiang,Chao Wang,Guodong Lian

doi:10.1186/1477-7819-10-120

Abstract

Leiomyosarcoma of the inferior vena cava (IVCL) is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins) IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

Highlights

Leiomyosarcoma of the inferior vena cava (IVCL) is a rare malignant tumor originating from the smooth muscle cells of the media with intraluminal or extraluminal growth
The origin of IVCL is further divided into three levels in relation to hepatic and renal veins: Level I, lower level (IVC below renal veins); Level II, middle level; and Level III, upper level [2]
Patients with IVCL usually present with asymptomatic abdominal mass, multiple diagnostic imaging techniques are used for the diagnosis, including Doppler ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) [3]

Summary

Background

Leiomyosarcoma of the inferior vena cava (IVCL) is a rare malignant tumor originating from the smooth muscle cells of the media with intraluminal or extraluminal growth. CT scan showed a right retroperitoneal mass arising from inferior vena cava (Figure 1A). No distention of abdominal subcutaneous vein was found She was diagnosed with retroperitoneal tumor, suspected leiomyosarcoma of the inferior vena cava, and received selective exploratory laparotomy. The tumor was explored to originate from the inferior vena cava, and infiltrated into bilateral renal veins. Patient 2 A 66-year-old male patient was admitted to our department due to abdominal pain for 12 months The glomerular filtration rate examination and renogram revealed renal function was normal. He was diagnosed with retroperitoneal tumor, suspected IVCL, and received selective exploratory laparotomy. The tumor originated from the inferior vena cava and was invading the right renal. Doppler ultrasonography revealed no lower extremity venous stasis and thrombosis during the follow-up

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Discussion

Conclusions