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Uterine Vascular Aorta and/or Inferior Vena Cava Renal Vein

Uterine

Medical Journal Article Annotated Citations For Latest Pubmed/Medline Search for Leiomyosarcoma with uterine primary Aust N Z J Obstet Gynaecol 1999 May;39(2):246-8 Uterine leiomyosarcoma--a Singapore experience. Soh LT, Chew SH, Ang L. Kandang Kerbau Hospital, Singapore. Uterine leiomyosarcoma is an aggressive tumour. In our retrospective series of 27 patients, there were 25 with nonmyxoid high-grade leiomyosarcoma of the uterus. The stage distribution was Stage 1, 16; Stage 3, 5 and Stage 4, 4. In the patients with Stage 1 disease, 3 of the 8 patients who received adjuvant chemotherapy subsequently developed recurrent disease. In contrast, 6 of the 8 patients who did not receive adjuvant chemotherapy subsequently developed recurrent disease; 2 of the patients in the latter group also received adjuvant radiotherapy. Six of the 9 women with recurrences were distant 'failures' alone, 2 were both distant and pelvic 'failures' and 1 was pelvic 'failure' alone. All the patients with advanced-stage disease eventually succumbed to the disease despite the therapies given. This study is small and retrospective but it suggests that there might be a role for adjuvant chemotherapy in the management of the early stage of this disease. Fetch PMID: 10755790 Cancer 2000 Mar 15;88(6):1425-31 Analysis of clinicopathologic prognostic factors for 157 uterine sarcomas and evaluation of a grading score validated for soft tissue sarcoma. Pautier P, Genestie C, Rey A, Morice P, Roche B, Lhomme C, Haie-Meder C,Duvillard P. Department of Medical Oncology, Institut Gustave Roussy, Villejuif Cedex, France. Uterine sarcomas (US) are rare and carry a poor prognosis characterized by high rates of local recurrence and metastasis. The aim of this study was to test the prognostic impact of the histologic grade for soft tissue sarcomas (STS). The three major histologic criteria: tumor differentiation, mitotic count, and tumor necrosis as well as other histologic and clinical factors were tested. The study included 78 leiomyosarcomas (LMS),. For LMS, stage and mitotic count were the only factors that had an influence on survival and relapse. [ed. this abstract was heavily edited and summarized because of the copyright.] Copyright 2000 American Cancer Society. Fetch PMID: 10717626 Arch Pathol Lab Med 2000 Feb;124(2):221-7 Uterine smooth muscle tumors: utility of classification by proliferation, ploidy, and prognostic markers versus traditional histopathology. Layfield LJ, Liu K, Dodge R, Barsky SH. Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA. CONTEXT: Accurate categorization of uterine smooth muscle neoplasms by light microscopic examination is difficult. Multiple classification schemes have been proposed based on mitotic rate, nuclear atypia, and the presence or absence of necrosis. None of these classification systems has been entirely successful. Multiple ancillary techniques have been tested for their ability to predict behavior of uterine smooth muscle tumors. OBJECTIVE: We assayed 45 smooth muscle neoplasms for a variety of proliferation markers, oncogene protein products, and DNA ploidy level to determine if these markers supplied prognostically useful information over and above that obtained by routine light microscopic assessment. STUDY DESIGN: Forty-five uterine smooth muscle neoplasms were assessed for DNA ploidy; silver-staining nucleolar organizer regions (AgNORs); percent nuclear proliferating cell nuclear antigen (PCNA); expression of p53, Her-2/neu, and MDM-2 protein; mitotic rate; and nuclear grade. These markers were correlated with histologic diagnosis and the occurrence of a clinically adverse event (death, metastasis, or recurrence). RESULTS: Diagnostic category (P <.001), nuclear grade (P <.002), mitotic activity (P <.001), mean AgNORs (P <.001), percent nuclear PCNA (P =.02), and expression of p53 (P =.02) all correlated with clinical outcome. No statistically significant correlation between clinical outcome and the categories MDM-2 expression, Her-2/neu expression, or DNA ploidy was seen. Nuclear grade, p53 expression, mitotic rate, AgNORs, and percent nuclear PCNA correlated with diagnosis. CONCLUSIONS: Diagnostic category, mitotic rate, AgNOR counts, PCNA, and p53 expression dichotomized uterine smooth muscle neoplasms into prognostically favorable and unfavorable groups. Although highly significant, the category AgNORs was no more successful than mitotic rate in dividing uterine smooth muscle neoplasms into prognostically favorable and unfavorable groups. Expression of p53 and percent nuclear PCNA dichotomized uterine smooth muscle neoplasms into prognostic groups, but neither technique reached the level of significance achieved by mitotic rate. Our data indicate that mitotic rate and the classification system of Kempson and Bari are at least as effective as the tested markers in separating uterine smooth muscle neoplasms into prognostic categories. Fetch PMID: 10656730 Gynecol Oncol 1998 Jan;68(1):54-61 Leiomyosarcoma of the uterus: A clinicopathologic, DNA flow cytometric, p53, and mdm-2 analysis of 49 cases. Blom R, Guerrieri C, Stal O, Malmstrom H, Simonsen E. Department of Gynecological Oncology, University Hospital, Linkoping, Sweden. [edited heavily by me. d] : Forty-nine patients were diagnosed with uterine leiomyosarcoma (25 stage I, 4 stage II, 8 stage III, and 12 stage IV). Of the 49 patients, 35 (71%) died of disease and 2 died of intercurrent disease. The 5-year survival rate was 33%. In a multivariate analysis with survival as the end point, stage was found to be the most important factor . All p53 immunopositive stage I-II tumors recurred within 28 months from diagnosis. CONCLUSION: This study found that stage represents the most important prognostic factor for uterine leiomyosarcomas. In stage I patients, tumor grade gives significant information regarding clinical outcome. In addition, p53 overexpression may predict a higher risk of recurrence in early stage leiomyosarcomas. Copyright 1998 Academic Press. Fetch PMID: 9454661 Bull Cancer 1997 Jun;84(6):625-9 [Uterine sarcoma treated by surgery and postoperative radiation therapy. Patterns of relapse, prognostic factors and role of radiation therapy]. [Article in French] Coquard R, Romestaing P, Ardiet JM, Mornex F, Sentenac I, Gerard JP. Service de radiotherapie-oncologie, Centre Hospitalier Lyon Sud, Pierre-Benite, France. The objective was to evaluate the results of a combination of surgery and postoperative radiotherapy in patients with uterine sarcoma, to describe the patterns of relapse and to define prognostic factors. From 1980 to 1993, 29 patients (median age: 56 years) presenting with uterine sarcoma have been treated with surgery and postoperative irradiation. The histology was:leiomyosarcoma: 11; carcinosarcoma: 12; stromal sarcoma: 6. The distribution by stage was: pT1: 18; pT2: 5; pT3: 3; pT4: 3; pNO: 27; pN1: 2. Gross residual disease was present in 4 patients. External beam irradiation was performed in all the cases and brachytherapy in 19. Chemotherapy was given in 3 patients. The overall survival rate was 66% at 2 years and 57% at 5 years with a disease free survival of 54% at 2 years and 50% at 5 years. Seven patients relapsed locally and 8 developed metastases. One patient died of ileitis. In a multivariate analysis, the disease free survival was strongly influenced by the menopausal status. The survival in this study is higher than that described in series of patients treated with surgery alone. This study confirms the worse prognosis of uterine sarcoma in postmenopausal women.[ ed. Did they have a lot of low stage patients or not?] Publication Types: Review, multicase Fetch PMID: 9295866 Eur J Gynaecol Oncol 1997;18(3):192-5 Uterine sarcoma: a clinicopathological study of 93 cases. Gonzalez-Bosquet E, Martinez-Palones JM, Gonzalez-Bosquet J, Garcia Jimenez A, Xercavins J. Department of Gynecologic Surgery/Gynecologic Oncology, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, Spain. OBJECTIVE: To evaluate the clinical outcome of patients suffering from primary uterine sarcoma diagnosed and treated in our Hospital. SETTING: Department of Gynecologic Surgery/Gynecologic Oncology, Hospital Universitario Materno-Infantil Vall d'Hebron de Barcelona, Barcelona, Spain. SUBJECTS AND METHODS: A retrospective review from 1967 to 1995 of clinical and pathological characteristics of 93 patients with primary uterine sarcoma was done. Patients were staged using the 1988 FIGO histological classification for uterine cancer. Clinical features, type of surgery, adjuvant therapy, recurrences, distant metastasis, and survival were recorded. RESULTS: Our study included three main histologic types: 44 patients with leiomyosarcoma, 26 patients with endometrial stromal sarcoma, and 18 patients with mixed Mullerian sarcomas. The mean age for all patients was 54.8 years, and the most common symptom was vaginal bleeding. Other clinicopathological features were examined. Although surgery was the most frequent treatment, adjuvant therapies have been analyzed and discussed. The overall three-year survival rate was 67.9% and the overall five-year survival rate was 64.5%. We found statistical differences (p < 0.001) between the stage I survival rate and other stage survival rates. CONCLUSIONS: Uterine sarcoma is an uncommon neoplasia diagnosed in the 6th decade of life. Leiomyosarcoma is the most frequent histologic type (47.3%). Stage I uterine sarcoma has a better prognosis than other stages. Fetch PMID: 9174834 J Surg Oncol 1997 Jan;64(1):55-62 0 Uterine sarcoma in the south of Israel: study of 36 cases. Piura B, Rabinovich A, Yanai-Inbar I, Cohen Y, Glezerman M. Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel. BACKGROUND: Uterine sarcomas are rare, charaterized by rapid clinical progression and poor prognosis, and their management has been a challenge. The purpose of this study was to investigate the clinical and histologic findings, treatment, and outcome of patients with uterine sarcoma in the south of Israel. METHODS: Data from the files of 36 patients with uterine sarcoma who were managed at the Soroka Medical Center between January 1961 and December 1994 were evaluated. RESULTS: The 5-year survival rate was 32% overall; 63% for 9 patients with endometrial stromal sarcoma (ESS). 30% for 14 patients with mixed mesodermal sarcoma (MMS) and 18% for 13 patients[ ed. presumably mostly high staged patients with extensive disease]: with leiomyosarcoma (LMS) [and overall sarcoma group statistics per stage] 41% for 22 patients with Stage I and 19% for 14 patients with Stages II, III, and IV. Only the difference in the 5-year survival rate between ESS and LMS was statistically significant (P < 0.05). Eleven patients (30.6%) were treated with surgery alone, 4 (11.1%) with surgery followed by pelvic radiotherapy, 11 (30.6%) with surgery followed by chemotherapy, 8 (22.2%) with surgery followed by pelvic radiotherapy and chemotherapy, one (2.8%) with chemotherapy alone, and one (2.8%) had no treatment. CONCLUSIONS: Uterine sarcomas are aggressive tumors with a poor prognosis. The treatment is surgery generally followed by adjuvant pelvic radiotherapy and/or systemic chemotherapy. Fetch PMID: 9040802 43: Br J Radiol 1993 Nov;66(791):998-1001 Uterine sarcomas: a review of the Edinburgh experience from 1974 to 1992. Tinkler SD, Cowie VJ. Department of Clinical Oncology, Western General Hospital, Edinburgh, UK. A retrospective review of patients treated for a uterine sarcoma in Edinburgh from 1974 to 1992 has been performed. Clinical details at presentation, tumour pathology, treatment and the outcome of treatment were all recorded. 82 patients' case notes were reviewed. 54 patients had died and 28 were alive (mean follow-up period 80.3 months). 39 patients had a malignant mixed mesodermal tumour, 12 patients had an endometrial stromal sarcoma, and 27 had a leiomyosarcoma. Using a modified FIGO staging retrospectively, 41 patients had Stage 1 disease, two patients had Stage 2, 16 patients had Stage 3, and 13 patients had Stage 4 disease. Definitive treatment of total abdominal hysterectomy and bilateral salpingo-oophorectomy was used in 69 patients, with 35 of these patients also receiving post-operative radiotherapy to the pelvis. 13 patients did not undergo surgery. Five of these patients received radical radiotherapy, three patients received palliative radiotherapy, and five patients were not treated. The overall median survival is 15 months and the 5-year actuarial survival is 31%. 25 of the 26 surviving patients had Stage 1 disease at presentation. Post-operative pelvic radiotherapy did not influence either survival or local tumour control. 51 of the 54 patients who relapsed had evidence of distant metastases. We conclude that total abdominal hysterectomy and bilateral salpingo-oophorectomy remains the treatment of choice for uterine sarcomas. Fetch PMID: 8281393 Eur J Gynaecol Oncol 1993;14 Suppl:105-13 Different types and different prognosis-study of 310 uterine sarcomas. Nickie-Psikuta M, Gawrychowski K. Department of Gynaecological Oncology, Maria Slodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. Three hundred and ten cases of uterine sarcomas, among them, according to pathology: LMS (Leiomyosarcoma)--117,MMS (Mixed mesodermal sarcoma)--62, ESS (Endometrial stromal sarcoma)--56, CS (Carcinosarcoma)--27, RBMS (Rhabdomyosarcoma)--18 and other sarcomas--30, were retrospectively evaluated at the Maria Sklodowska-Curie Memorial Cancer Center between 1950 and 1985. These mesodermal tumors were divided into uterine corpus sarcomas (295) and the rarely occurring uterine cervix sarcomas. As the main modality of treatment 307 patients underwent surgery. Almost all patients received adjuvant radiotherapy but 51 cases of LMS. Overall 5-year survival was 34.5% and in particular subgroups the survivals were as follows: the best, 52% in LMS; lower, 30% in ESS; poor survival about 20% in CS and MMS. In spite of low curability in the majority of subgroups except LMS, the cases of CS with primary site in uterine cervix distinguished itself with better results. No significant survival advantage was found for surgery plus radiotherapy in LMS with low grade mitotic activity, (10 mitoses/10 HPF) compared with surgery alone (63% and 54%). These cases seem to have better prognosis in LMS with high grade mitotic activity (10 mitoses/10 HPF) and do not require adjuvant radiotherapy. Fetch PMID: 8200360 Br J Obstet Gynaecol 1992 Jul;99(7):590-4 Leiomyosarcomas have a poorer prognosis than mixed mesodermal tumours when adjusting for known prognostic factors: the result of a retrospective study of 423 cases of uterine sarcoma. Olah KS, Dunn JA, Gee H. Academic Department of Obstetrics and Gynaecology, Birmingham Maternity Hospital, Edgbaston, UK. OBJECTIVE: To determine the survival data for the various tumour types of uterine sarcoma and determine the influence of various prognostic factors on survival. DESIGN: Retrospective analysis of all uterine sarcoma cases registered in the 15 year period 1967-1981. SETTING: West Midlands Regional Cancer Registry, serving a catchment area of 2.6 million women. SUBJECTS: 423 women registered as having a uterine sarcoma; 367 of these were associated with the two main histological types, leiomyosarcomas (LMS) and mixed mesodermal tumours (MMT). MAIN OUTCOME MEASURES: Duration of survival was taken as the primary endpoint. RESULTS: The overall 5-year survival for uterine sarcomas in this series was 31%, with the major prognostic indicator being tumour stage. Survival for mixed mesodermal tumours is similar to other sarcomas despite a tendency towards less differentiation, wider dissemination and a greater age of the patient at diagnosis. Multivariate analysis shows that for cases with similar stage, age and grade, mixed mesodermal tumours have a better prognosis than leiomyosarcomas. CONCLUSIONS: These results demonstrate the danger of considering each variable in isolation when the relation between variables can lead to spurious significance or lack of significance because of the imbalances in the numbers between groups of prognostic importance. This study underlines the need for an adequate inspection of the intra-abdominal contents at the time of hysterectomy for uterine fibroids. Fetch PMID: 1326319 Acta Oncol 1990;29(2):185-91 Prognostic factors in uterine leiomyosarcoma. A clinical and histopathological study of 143 cases. The Radiumhemmet series 1936-1981. Larson B, Silfversward C, Nilsson B, Pettersson F. Department of Obstetrics and Gynecology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden. One hundred and forty-three patients with uterine leiomyosarcomas treated at Radiumhemmet from 1936 through 1981 were reviewed. Clinical and histopathological findings were analysed by bivariate and multivariate analyses to assign prognostic factors. Mitotic count, menopausal status and stage showed to be significant predictors of survival. The series was divided into two periods of time and a significantly higher survival rate in the second period was noted for patients with stage I disease. Thirty-seven patients with tumors showing less than 10 mitotic figures per 10 high power fields had a 5-year survival rate of 65% compared with 17% for 106 patients with 10 or more mitotic figures per 10 high power field. No significant predictor of a bad outcome for these low mitotic count tumors was found. Fetch PMID: 2334571 Am J Obstet Gynecol 1979 Jul 1;134(5):557-64 Uterine leiomyosarcoma. Hannigan EV, Gomez LG. A series of uterine leiomyosarcomas was reviewed in an attempt to assign prognostic significance to clinical and pathologic features. Extension of the sarcoma at the time of initial diagnosis was associated with a dismal outcome; no patient with disease beyond the confines of the uterus survived. Histologic grade was a useful prognostic feature, although low-grade sarcoma can be associated with metastases. Mitotic count was also useful in prognosis, although it did not correlate as well with clinical outcome as did histologic grade. There was no number of mitoses below which the diagnosis of leiomyosarcoma was excluded. Fetch PMID: 453295

Vascular

Medical Journal Article Annotated Citations For Latest Pubmed/Medline Search on Leiomyosarcoma with vascular primary Eur J Surg Oncol 1991 Apr;17(2):125-34 Leiomyosarcoma of large and small veins: clinical findings and results of treatment in six patients. van Gulik TM, Taat CW, Slors JF, Bras J, Blank LE, Bakker PJ, Kromhout JG, Brummelkamp WH. Department of Surgery, University of Amsterdam, The Netherlands. Vascular leiomyosarcomas are rare malignant tumours originating from the media of the vessel wall. Six patients (five women and one man, aged 44-66 years) have been treated for a vascular leiomyosarcoma located in the inferior vena cava (three patients), the suprarenal, the external iliac and an antecubital vein. In four patients, the tumour was large and extended beyond the vessel wall giving rise to a retroperitoneal mass. In two patients the tumour was confined to the inner wall of respectively a large and small vein, occluding the lumen; the former was in the inferior vena cava and the latter in an antecubital vein. Block resection was performed in all patients. The tumours showed mitotic indices ranging from 6-32 mitoses/10 high power fields. The five patients with retroperitoneal tumours received additional radiotherapy varying from 50.00-70.00 Gy, on the basis of either macroscopic residual tumour or indefinite radicality. One of these five patients developed distant metastases within 2.5 years without local recurrence, the other four had no evidence of recurrence at follow-up, 3-7 years (mean 4.2 years) after surgery. The results illustrate the role of adjuvant radiotherapy in the control of local recurrence, when resection in this type of tumour proves to be either non-radical or totally radical. Fetch PMID: 2015919 Cancer 1986 Apr 1;57(7):1395-400 Intramural venous leiomyosarcomas. Leu HJ, Makek M. Five cases of intramural venous leiomyosarcomas are described. Only one was localized in the inferior vena cava, the classic site; the other four cases were situated in smaller veins, namely, the short and long saphenous veins, the external jugular vein, and a superficial vein at the back of the hand. Light and, in two cases, electron microscopy, as well as immunohistochemical examinations for factor VIII, helped to establish the diagnosis. The fate of these cases indicates that size and localization are the main determining factors of outcome, whereas the level of mitotic activity is informative only if it is high. Small tumors in superficial veins that are detected early may have an excellent prognosis, even after limited removal of the tumor. Fetch PMID: 3081244

Aorta and/or Inferior Vena Cava

Medical Journal Article Annotated Citations For Latest Pubmed/Medline Searches: Leiomyosarcoma with primary of IVC Leiomyosarcoma with primary of aorta Leiomyosarcoma with primary of pulmonary artery Cancer 1999 Mar 1;85(5):1077-83 Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR. Department of Surgery, University of California-Los Angeles School of Medicine, 90095, USA. BACKGROUND: Leiomyosarcoma of the inferior vena cava (IVC) is an uncommon tumor that many believe portends a poor prognosis compared with leiomyosarcoma with similar histology at other anatomic sites. Because of the limited international experience with this disease, the optimal management of these patients is unknown. METHODS: From October 1978 to January 1997,14 patients with leiomyosarcoma of the IVC were treated at the University of California-Los Angeles Medical Center. Wide resection was attempted in all patients. The characteristics of each patient were documented and compared with those of patients with leiomyosarcoma of the stomach (n = 13), small intestine (n = 18), retroperitoneum (n = 19), and uterus (n = 10) who were treated during the same time period. RESULTS: Age, gender, tumor size, tumor grade, and lymph node status did not impact survival of patients with leiomyosarcoma of the IVC. Patients with positive surgical margins fared significantly worse (P < 0.03) compared with those who underwent complete resection. Radiation therapy diminished local recurrence and may improve median survival (6 months [n = 2] vs. 51 months [n = 12]) in this patient population. Patients who received combined chemotherapy and radiation lived longer than those who did not (P < 0.05). The 5-year cumulative survival rate (Kaplan-Meier method) was 53% for patients with leiomyosarcoma of the IVC, 47% for those with leiomyosarcoma of the stomach, 43% for those with leiomyosarcoma of the small intestine, 56% for those with leiomyosarcoma of the retroperitoneum, and 65% for those with leiomyosarcoma of the uterus. CONCLUSIONS: Despite having a tumor that originates from the IVC, patients with this tumor type can enjoy reasonably long term survival. It appears that these patients benefit from radiation therapy to control local disease. Survival of these patients is no worse than of patients with leiomyosarcomatous lesions of other origin. Aggressive surgical management combined with adjuvant therapy offers the best treatment for patients with leiomyosarcoma of the IVC. Fetch PMID: 10091791 J Vasc Surg 1998 Jul;28(1):75-81; discussion 82-3 Prosthetic replacement of the inferior vena cava for malignancy. Sarkar R, Eilber FR, Gelabert HA, Quinones-Baldrich WJ. Section of Vascular Surgery, University of California Medical Center, Los Angeles, USA. PURPOSE: Invasion of the inferior vena cava (IVC) by tumor is generally considered a criterion of unresectability. This study was designed to review the outcomes of a strategy of aggressive resection of the vena cava to achieve complete tumor resection coupled with prosthetic graft placement to re-establish caval flow. METHODS: Retrospective review of patients treated at a university referral center. Ten patients (mean age 54; eight females, two males) underwent tumor resection that involved circumferential resection of the IVC and immediate prosthetic replacement with ringed polytetrafluoroethylene (PTFE) grafts ranging in diameter from 12 to 16 mm. RESULTS: Seven patients had replacement of the infrarenal IVC, two of their suprarenal IVC, and one had reconstruction of the IVC bifurcation. Four of the 10 patients received preoperative chemotherapy, and none received radiotherapy. The most common (7/10) pathologic diagnosis was leiomyosarcoma arising from the IVC or retroperitoneum. Additional diagnoses included teratoma (one), renal cell carcinoma (one), and adrenal lymphoma (one). There were no perioperative deaths, and one complication (prolonged ileus) occurred. Mean length of stay was 8.1 days. Anticoagulation was not routinely used intraoperatively or postoperatively. Follow-up (mean duration = 19 months) demonstrated that survival was 80% (8/10) and 88% (7/8) of patients were free of venous obstructive symptoms. CONCLUSION: Resection of the IVC with prosthetic reconstruction allows for complete tumor resection and provides durable relief from symptoms of venous obstruction. Fetch PMID: 9685133 Anticancer Res 1996 Sep-Oct;16(5B):3201-5 International registry of inferior vena cava leiomyosarcoma: analysis of a world series on 218 patients. Mingoli A, Cavallaro A, Sapienza P, Di Marzo L, Feldhaus RJ, Cavallari N. 1st Department of Surgery, La Sapienza University, Rome, Italy. In 1992 The International Registry of Inferior Vena Cava (IVC) Leiomyosarcomas was established to study the pathogenesis and natural history of the tumor and to support the most rational treatment. We collected 218 patients through a literature review and personal communications. We corresponded with several Authors to obtain up-to-date follow-up and any other data lacking at the initial review. The series was analyzed to identify predictive factors for clinical outcome. Tumors arose from the IVC lower segment in 80 patients, from the middle in 94 and from the upper in 41. A radical tumor resection was undertaken in 134 (61.5%) patients, 26 (11.9%) had a palliative resection and 58 (26.6%) were inoperable. An increased risk of death was associated with upper IVC segment involvement (p < 0.001), lower limb edema (p < 0.001), Budd-Chiari's syndrome (p < 0.001), intraluminal tumor growth (p < 0.001) and IVC occlusion (p < 0.001). Radical tumor resection was associated with better 5- and 10-year survival rates (49.4% and 29.5%). Tumors which arose from the middle segment fared better (56.7% and 47.3%) than those of the lower segment (37.8% and 14.2%) (p < 0.002). No palpable abdominal mass and abdominal pain were associated, in patients radically operated, with a better outcome and longer survival (p < 0.03 and p > 0.04 respectively). Despite the high rate of recurrence, radical tumor resection is the only long-term cure. Fetch PMID: 8920790 Surg Today 1998;28(3):359-61 Leiomyosarcoma of the inferior vena cava. Resection and reconstruction of the renal vein using the gonadal vein. Yamaguchi R, Yamaguchi A, Isogai M, Hori A, Kin Y. Department of Surgery, Ogaki Municipal Hospital, Minaminokawa, Japan. We succeeded in surgically resecting a leiomyosarcoma of the inferior vena cava (IVC), which originated at the confluent portion of the right renal vein (RRV), together with the IVC and RRV, and also were able to preserve the right kidney by reconstructing the RRV with end-to-end anastomosis using the right gonadal vein. A good blood flow of the reconstructed RRV was thereafter confirmed by color Doppler ultrasonography, and the renal function was also satisfactory. This new procedure, a reconstruction of the RRV using the gonadal vein, has not been previously reported, but is considered to be an easy and effective method which enables the surgeon to preserve the normal right kidney. Fetch PMID: 9548329 Thorac Cardiovasc Surg 1997 Feb;45(1):43-5 Leiomyosarcoma of the inferior vena cava: novel surgical reconstruction preserves renal function. Babatasi G, Massetti M, Galateau F, Rossi A, Bhoyroo S, Khayat A. Department of Thoracic and Cardiovascular Surgery, University Hospital, Caen, France. Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a new case of primary leiomyosarcoma of the inter-renal vena cava is reported. Surgical treatment consisted of excision of the vena cava on top of the renal arteries allowing radical resection. Reconstruction was original. The distal vena cava was sectioned and ligated just above the bifurcation and the free segment used to replace the excised part. In this the right venal vein was directly implanted. The left renal vein was reimplanted in the translocated segment via a venous (femoral vein) graft. Ligation of the distal vena cava was haemodynamically well-tolerated and the patient was free of symptoms at one year after operation. Control angiogram showed patency of the venous reconstruction. Early diagnosis is essential to improve patient survival, since it allows better radical resection, which is the only way of preventing the development of metastases. Fetch PMID: 9089976

Renal Vein

Medical Journal Article Annotated Citations For Latest Pubmed/Medline Search on Leiomyosarcoma with primary of renal vein Nippon Hinyokika Gakkai Zasshi 2001 Jan;92(1):38-41 [A case of leiomyosarcoma of the renal vein]. [Article in Japanese] Hiratuka Y, Ikeda H, Sugaya Y, Tozuka K, Yamada S. Department of Urology, Jichi Omiya Medical Center. A 54-year-old woman presented with a 6-month history of left back pain. She had undergone left mastectomy for breast cancer in 1993 and hysterectomy for cervical cancer in 1997. Excretory urography showed no abnormality in the left collecting system, but right hydronephrosis caused by a midureteral stone. She was treated by transurethral ureterolithotripsy first. Computerized tomography showed a 4 x 3 cm. mass enhanced slightly by contrast medium at the left renal hilus. The tumor was bordered laterally by the left kidney and posteriorly by the left renal vein which appeared normal on magnetic resonance imaging. Selective left renal angiography revealed no abnormality. Radical en bloc excision of the tumor with the left kidney and adrenal gland was performed. Pathological examination showed a well differentiated leiomyosarcoma arising from the renal vein; the tumor cells stained positive for alpha-smooth muscle actin, vimentin and desmin and negative for S 100-protein. She was free of symptoms and there was no evidence of local recurrence or distant metastases 22 months postoperatively. Fetch PMID: 11235142 J Surg Oncol 1996 Nov;63(3):195-200 Leiomyosarcoma of the renal vein. Brandes SB, Chelsky MJ, Petersen RO, Greenberg RE. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA. The preoperative diagnosis for primary leiomyosarcoma of the renal vein, an extremely rare tumor, is difficult. The tumor predominantly occurs in women and on the left side. Its natural history is toward distant metastases and a poor 5-year survival rate. Nephrectomy and en-bloc surgical resection remain the mainstay of therapy. We present three such cases and review the world literature. Review of reported cases Fetch PMID: 8944066 Ann Urol (Paris) 1992;26(6-7):333-5 [Primary leiomyosarcoma of the left renal vein]. [Article in French] Lakhloufi A, Khaiz D, Abi F, Bouzidi A. Service de Chirurgie Generale, CHU Ibn Rochd, Casablanca, Maroc. The authors report a case of leiomyosarcoma of the left renal vein. Because of its retroperitoneal position, this exceptional tumour was responsible for few symptoms. Complementary investigations (CT scan, ultrasonography, arteriography) often do not confirm the diagnosis. Complete surgical excision combined with complementary treatment can ensure long-term survival. Publication Types: Review of reported cases Fetch PMID: 1366135 Urology 1991 Sep;38(3):255-8 Leiomyosarcoma of renal vein. Grignon DJ, Ro JY, Papadopoulos NE, Ayala AG. Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston. Leiomyosarcomas arising from the renal vein are rare tumors: only 13 cases are found in the literature. We report a case in a sixty-one-year-old woman who presented with back pain and hematuria. She underwent resection of the tumor and an ipsilateral nephrectomy. The tumor recurred locally, and the patient died thirty months after diagnosis. Review of the cases reported in the literature reveals the aggressive nature of these tumors and the need for a combined therapeutic approach. Review of reported cases Fetch PMID: 1887540

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