Shimoda H, Oka K, Otani S, Hakozaki H, Yoshimura T, Okazaki H, Nishida S, Tomita S, Oka T, Kawasaki T, Mori N
Department of Orthopedics, Mito Saiseikai General Hospital, Ibaraki, Japan.
Virchows Arch. 1998 Jul;433(1):97-100. doi: 10.1007/s004280050223.
A 61-year-old woman developed pain in the right thigh, paraplagia of the lower extremities and lumbago in November 1996. A lumbar spine roentgenogram showed lytic change in L2, and magnetic resonance imaging showed a patchy destructive lesion and compression of the dural sac from the right by a tumour. Computed tomography (CT) myelography showed a motheaten destructive lesion in L2 and projection of the tumour into the spinal canal. Abdominal ultrasound, CT and cavography showed dilatation of the inferior vena cava (IVC) and an intraluminal tumour about 2x2.8x4 cm in size in the IVC. The tumour arose from the IVC just beneath the renal vein and extended to just short of the right atrium. Both vertebral and intraluminal biopsy materials showed the same morphology, in which atypical spindle cells admixed with multinucleated giant cells proliferated in a fascicular growth pattern. Neoplastic cells were strongly positive for alpha-smooth muscle actin. We diagnosed vascular leiomyosarcoma arising from the IVC with metastasis to the lumbar vertebrae. Cases of vascular leiomyosarcoma diagnosed by intraluminal biopsy are rare.
一名61岁女性于1996年11月出现右大腿疼痛、下肢截瘫和腰痛。腰椎X线片显示L2有溶骨性改变，磁共振成像显示有斑片状破坏性病变，且有一肿瘤从右侧压迫硬脊膜囊。计算机断层扫描（CT）脊髓造影显示L2有虫蚀样破坏性病变，肿瘤突入椎管。腹部超声、CT和腔静脉造影显示下腔静脉（IVC）扩张，IVC内有一大小约为2×2.8×4 cm的腔内肿瘤。肿瘤起源于肾静脉下方的IVC，延伸至距右心房仅差一点的位置。椎体和腔内活检材料显示相同的形态，其中非典型梭形细胞与多核巨细胞混合，呈束状生长模式增殖。肿瘤细胞α-平滑肌肌动蛋白呈强阳性。我们诊断为起源于IVC并转移至腰椎的血管平滑肌肉瘤。通过腔内活检诊断血管平滑肌肉瘤的病例罕见。
