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DOI: 10.1055/a-2192-0576
Diagnosis and preoperative evaluation of vena cava mass by endoscopic ultrasound: “hunting” for the overlooked lesions
A 53-year-old woman was admitted to our hospital with right-sided lower abdominal pain lasting for 1 year. Her laboratory tests were unremarkable. Computed tomography (CT) and CT angiography revealed a 4.7 × 4.0 × 5.4 cm mass along the posterior head of the pancreas and invading the inferior vena cava (IVC) ([Fig. 1], [Video 1]). Endoscopic ultrasound (EUS) found a solid hypoechoic lesion separate from the pancreas, which was growing transmurally and partially protruding outside the IVC wall and encroaching upon the right renal and hepatic veins. For a definitive diagnosis, we performed EUS-guided fine-needle aspiration (EUS-FNA) of the tissue mass through the duodenum, using a 22-gauge needle ([Fig. 2]).
Qualität:
The pathological examination found that the mass was composed of spindle cells, and immunohistochemistry showed that it was positive for vimentin, desmin, SMA, H-caldesmon, and Ki67 (+, 40%), and negative for CD34, CD117, DOG1, S100, SOX11, MDM2, CDK4, and p16, indicating the diagnosis of leiomyosarcoma ([Fig. 3]). The patient was referred to surgeons for further management.
Leiomyosarcoma of the IVC is a rare cause of unexplained abdominal pain in patients [1]. Biopsy is generally considered challenging due to its deep location and risk of bleeding from the IVC, and preoperative misdiagnosis and diagnostic delays before surgery are frequent, which means that many patients are initially treated inappropriately [2] [3]. Different surgical resection techniques and approaches are dependent on the level of IVC involvement, the tumor extension, and the presence or absence of collateral veins [4]. In our case, we demonstrated that EUS-FNA may be a simple, safe, and minimally invasive diagnostic method for a vena cava mass. Moreover, EUS could detect invasion of the right renal and hepatic veins more accurately than CT angiography, which is helpful when making a precise plan for surgery.
Endoscopy_UCTN_Code_CCL_1AF_2AZ_3AB
E-Videosis an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website athttps://mc.manuscriptcentral.com/e-videos.
Publikationsverlauf
Artikel online veröffentlicht:
24. November 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
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- 3 Alkhalili E, Greenbaum A, Langsfeld M. et al. Leiomyosarcoma of the inferior vena cava: a case series and review of the literature. Ann Vasc Surg 2016; 33: 245-251
- 4 Dew J, Hansen K, Hammon J. et al. Leiomyosarcoma of the inferior vena cava: surgical management and clinical results. Am Surg 2005; 71: 497-501