Primary leiomyoma of the great saphenous vein using multimodal imaging

Abstract

A 28-year-old man had presented with a complaint of a mass in the left lower limb that had been present for 10 years. The mass had increased slowly, with aggravated pain during the most recent week. On physical examination, a soft mass was present in the front of left lower limb with poor activity, and preserved sensation and palpable arterial pulses within the distal extremity. Ultrasound revealed a hypoechoic lesion without a shape change after compression around the distal great saphenous vein. The lesion measured 1.9 × 1.3 × 2.1 cm, with a well-circumscribed boundary that seemed to be a continuation of the venous wall (A). Some dot-like blood flow signals were detected inside the lesion with a pulsatile arterial spectrum. The great saphenous vein was patent with intact intima (B/Cover). Magnetic resonance imaging was further performed, which revealed an equal T1-weighted signal and an equal or a long T2-weighted signal, similar to that for muscle tissue, for the mass. Continuous and intact adventitia was observed, which confirmed that the mass was localized to the vascular wall (C). A tentative preoperative diagnosis was a muscle-derived benign tumor of the great saphenous vein wall. The possibility of malignancy was excluded by the slow progression, clear boundary, and no invasiveness. The patient subsequently underwent resection of the mass without vascular reconstruction, and the excised mass displayed a fish-flesh cut surface. Postoperative pathologic examination revealed the mass was composed of benign spindle cells with a reticular or parallel arrangement and was positive for smooth muscle actin and desmin (D). Ultimately, the definite diagnosis was a primary leiomyoma of the great saphenous vein. The patient recovered uneventfully without complications. The patient provided written informed consent for the report of his case details and imaging studies.