The use of Palma's procedure in the salvage therapy for a leiomyosarcoma of the right pelvic sidewall: an intraoperative multidisciplinary approach

Abstract

Leiomyosarcomas of the ovary and broad ligament are relatively rare. Less than 50 cases of primary ovarian and broad ligament leiomyosarcomas have been reported. The prognosis is poor, with late-stage disease being a problem in the majority of cases. It is difficult to determine the exact role of surgery, chemotherapy, and radiotherapy in the management of these tumors. So far, no cases of ovarian or broad ligament leiomyosarcomas have been reported where primary surgery for the sarcoma had to be combined with a Palma's procedure. We report a case of a right pelvic sidewall leiomyosarcoma with involvement of 10 cm of the right external iliac vein. A review of the imaging preoperatively did not suggest involvement of the venous system. Resection of the pelvic mass was carried out and a Palma's procedure was performed by the vascular surgeon. Histology reported an incompletely excised high-grade leiomyosarcoma. Chemotherapy was given postoperatively. Imaging at 12 months after surgery showed a patent vascular graft and no evidence of recurrence. There was no clinical evidence of recurrence at 21 months postsurgery.