Diagnosis, treatment and prognosis of the leiomyosarcoma of the inferior vena cava. Three cases and summary of published reports.
OBJECTIVE
To describe our experience with three cases of leiomyosarcoma of the inferior vena cava, and summarise current methods of diagnosis and treatment.


METHODS
Descriptive study.


METHODS
University hospital, Germany.


METHODS
3 Patients with histologically confirmed leiomyosarcoma of the inferior vena cava.


METHODS
Resection, with or without vascular reconstruction.


METHODS
Morbidity and mortality.


RESULTS
Case 1 was diagnosed on magnetic resonance imaging, the tumour was resected, and the vena cava replaced with a polytetrafluoroethylene (PTFE) graft. She made an uncomplicated recovery and was well and free of symptoms 10 months later. Case 2 was diagnosed at operation (the differential diagnosis on computed tomography was a retroperitoneal tumour), the tumour was resected, and the defect oversewn. She made an uneventful recovery and was well and free of symptoms 14 months later. Case 3 was diagnosed at operation (a diagnosis of pancreatic cancer had been made preoperatively), the tumour was resected, and the defect oversewn. She was well and free of symptoms 10 months after operation.


CONCLUSIONS
Magnetic resonance imaging is superior to computed tomography in the diagnosis of leiomyosarcoma of the inferior vena cava. The treatment of choice is resection; small defects can be closed by suture or PTFE patch, and large defects by PTFE prostheses. Reported resectability is 40% to 60%, but the prognosis is poor; the local recurrence rate is about 36%, most patients are dead within 2.5 years, and the 5-year survival is 30%. Chemotherapy and radiotherapy will give some degree of palliation, but do not affect the outcome.
Mönig
S P
SP
Department of Surgery, University of Colonge, Germany.
Gawenda
M
M
Erasmi
H
H
Zieren
J
J
Pichlmaier
H
H
D000368:Aged; D001807:Blood Vessel Prosthesis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011379:Prognosis; D014652:Vascular Diseases / Q000175:diagnosis* / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery*
D011138:Polytetrafluoroethylene