Xu Jing, Velayati Arash, Berger Barbara J, Liu Ming, Cheedella Naga K Sucharita, Gotlieb Vladimir
Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
Department of Infectious Disease, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
Am J Case Rep. 2017 Nov 3;18:1160-1165. doi: 10.12659/ajcr.905787.
BACKGROUND Leiomyosarcoma is the most common primary malignancy of the inferior vena cava (IVC), and represents approximately 10% of primary retroperitoneal sarcomas. Leiomyosarcoma presents with non-specific symptoms, including abdominal pain or back pain. There is an increased incidence in immunosuppressed individuals. CASE REPORT An unusual presentation of IVC leiomyosarcoma is reported in a 46-year-old female patient infected with human immunodeficiency virus (HIV) who was on highly active antiretroviral therapy (HAART) and who had a normal CD4 count of 934, who presented with back pain. Magnetic resonance imaging (MRI) of the lumbar spine showed a mass of the IVC. Initial computed tomography (CT)-guided biopsy of the IVC mass was non-diagnostic. An IVC filter was inserted, and the patient was discharged home, but 20 days later, she returned to the hospital with worsening right flank pain. Laboratory tests showed acute renal failure, and a repeat CT scan showed IVC thrombus extending 5 cm superiorly. When compared with the previous CT, there was an extension of thrombus into both renal veins. Histopathology of a transjugular needle core biopsy showed a moderately differentiated leiomyosarcoma. The patient was transferred to a multidisciplinary sarcoma center for surgical resection, chemotherapy, and radiation therapy. CONCLUSIONS This report is of a rare case of IVC leiomyosarcoma in a middle-aged HIV-positive woman with a normal CD4 count. Leiomyosarcoma of the IVC is extremely rare, is often detected when advanced, and has a poor prognosis. This case report describes the clinical, imaging, surgical and histopathological findings of leiomyosarcoma of the IVC.
平滑肌肉瘤是下腔静脉最常见的原发性恶性肿瘤，约占原发性腹膜后肉瘤的10%。平滑肌肉瘤表现为非特异性症状，包括腹痛或背痛。免疫抑制个体的发病率增加。病例报告：本文报告了一名46岁感染人类免疫缺陷病毒（HIV）的女性患者，该患者正在接受高效抗逆转录病毒治疗（HAART），CD4计数正常，为934，表现为背痛，这是下腔静脉平滑肌肉瘤的一种不寻常表现。腰椎磁共振成像（MRI）显示下腔静脉有肿块。最初对下腔静脉肿块进行的计算机断层扫描（CT）引导下活检未明确诊断。植入了下腔静脉滤器，患者出院回家，但20天后，她因右侧胁腹疼痛加重返回医院。实验室检查显示急性肾衰竭，重复CT扫描显示下腔静脉血栓向上延伸5 cm。与之前的CT相比，血栓延伸至双侧肾静脉。经颈静脉针芯活检的组织病理学检查显示为中度分化的平滑肌肉瘤。患者被转至多学科肉瘤中心进行手术切除、化疗和放疗。结论：本报告是一例罕见的中年HIV阳性女性下腔静脉平滑肌肉瘤病例，其CD4计数正常。下腔静脉平滑肌肉瘤极为罕见，通常在病情进展时才被发现，预后较差。本病例报告描述了下腔静脉平滑肌肉瘤的临床、影像学、手术和组织病理学表现。
