Pregnant female 36 years old. Tumor in the upperleg since 2 years but increasing in size during the last few months.
What would you do in this case? Would you wait because the patient is pregnant and the mass is there for 2 years and has smooth margins?
The irregular vascularization and a previous case of a malignant tumor in continuation with the greater saphenous vein (case 7.4.4 slide 1) made us decide to perform an ultrasound guided biopsy.
Biopsy proved the lesion to be a malignant leiomyosarcoma.
Leiomyosarcomas are usually hypoechoic with smooth margins. They are uncommon tumors arising of smooth muscle cells. They acount for about 7 percent of all sarcomas. Uterus stomach and intestines are much more common sites than peripheral vessels.
The patient was operated and the mass proved to be a high grade leiomyosarcoma of the wall of the greater saphenous vein.
Not all tumors in peripheral veins are malignant.
References
Le Minh T,Cazaban D Great saphenous vein leiomyosarcoma: a rare malignant tumor of the extremity--two case reports. Ann Vasc Surg. 2004 Mar;18(2):234-6
Kreft B, Flacke S, Diagnostic imaging of vascular leiomyosarcomas Rofo. 2004 Feb;176(2):183-90.
Louail B, Vautier-Rodary R, Value of imaging in early diagnosis of peripheral vein tumors J Radiol. 1998 Nov;79(11):1387-91
Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.
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