Striano Augusto, Esposito Francesco, Crafa Francesco
Oncological and General Surgery Unit, 'St. Giuseppe Moscati' Hospital of National Relevance and High Specialty, Avellino, Italy.
J Surg Case Rep. 2019 Nov 6;2019(11):rjz308. doi: 10.1093/jscr/rjz308. eCollection 2019 Nov.
Arterial leiomyosarcoma (A-LMS) is a very rare tumour and no cases originating from the superior mesenteric artery (SMA) have been described. We present a case of A-LMS originating from distal part of SMA and incorporating superior mesenteric vein (SMV). SMA and SMV were prepared along their course by laparotomy. Prior to resection, the superior mesenteric vessels were clamped, and intra-operative infrared angiography after intravenous injection of indocyanine green was performed. Once confirmed the vitality of the bowel, mass resection including the distal portion of the SMA and SMV was executed. The postoperative course was uneventful. Histology confirmed initial diagnosis. Six months after surgery no recurrence was highlighted. This is the first case of A-LMS originating from SMA, successfully treated without any intestinal resection or vascular reconstruction. The use of near-infrared angiography associated with a preoperative angiographic workup is indispensable for the success of the surgery.
动脉平滑肌肉瘤(A-LMS)是一种非常罕见的肿瘤,目前尚未见起源于肠系膜上动脉(SMA)的病例报道。我们报告一例起源于SMA远端并累及肠系膜上静脉(SMV)的A-LMS病例。通过剖腹手术沿SMA和SMV走行进行显露。在切除前,夹闭肠系膜上血管,并在静脉注射吲哚菁绿后进行术中红外血管造影。一旦确认肠管活力,便实施包括SMA和SMV远端部分的肿块切除术。术后病程顺利。组织学检查证实了初步诊断。术后6个月未发现复发。这是首例起源于SMA的A-LMS病例,成功治疗且未进行任何肠切除或血管重建。术前血管造影检查联合近红外血管造影对于手术成功必不可少。