125I Brachytherapy Seeds Implantation for Inoperable Low-Grade Leiomyosarcoma of Inferior Vena Cava
- Affiliations
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- 1Department of Interventional Therapy, The Second Hospital of Shandong University, Jinan 250033, China. lyl.pro@163.com
- KMID: 1482787
- DOI: http://doi.org/10.3348/kjr.2013.14.2.278
Abstract
- A 60-year-old female presented with abdominal pain and tenderness of five-day duration. Contrast enhanced CT showed a mass of 9 x 6 x 5.5 cm in size with almost complete obliteration of the inferior vena cava and massive extension to the extravascular space. CT-guided biopsy demonstrated a low-grade leiomyosarcoma. The patient underwent 125Iodine seeds implantation in two sessions, and another balloon cavoplasty. Abdominal pain and tenderness gradually improved and the patient continues to remain as disease free state for three years after the procedures.
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Figure
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Fig. 1 Tumor, pathology, treatments and follow-up CT. Intravenous contrast enhanced CT of mass. Axial view (A, arterial phase) at level of renal vein demonstrates huge mass (white arrow) involving inferior vena cava and partially surrounding left renal vein. Coronal reconstruction (B, venous phase) shows normal corticomedullary enhancement bilaterally, confirming normal function of both kidneys (white arrow). Histology and immunohistochemistry of leiomyo-sarcoma in inferior vena cava. H&E (C, × 200) stain reveals spindle cells (white arrow). Tumor is positive for desmin (D, × 400, brown) indicating leiomyosarcoma deriving from smooth muscle. E. Precontrast follow-up CT three months after two sessions of 125I implantation. Tumor size has markedly decreased and disappeared almost completely. Note high density spots of 125I seeds (white arrow). Balloon angioplasty for inferior vena cava (IVC) stenosis eight months after 2nd session of 125I seeds implantation. Inferior vena cavography before angioplasty (F) demonstrates stenosis and partial IVC obstruction, with retroperitoneal collateral circulation (white arrow) in keeping with IVC thrombosis. View after cavoplasty (G) shows almost normal lumen of IVC segment. H. Enhanced follow-up CT of 33 months after 2nd session of 125I seeds implantation. CT scan reveals disappearance of tumor without significant caval stenosis or thrombosis.
Reference
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