J Korean Soc Radiol.  2014 Jul;71(1):30-33. 10.3348/jksr.2014.71.1.30.

Multidetector CT and MR Imaging Findings of Renal Vein Leiomyosarcoma with Both Extraluminal and Intraluminal Components: A Case Report

• Hong H
• Ku YM
• Seo KJ
• Park SC
• Lee SL

• KMID: 1709018
• DOI: http://doi.org/10.3348/jksr.2014.71.1.30

Abstract

Leiomyosarcomas of the large veins are uncommon tumors commonly originating from the inferior vena cava. A primary leiomyosarcoma arising from the renal vein is very uncommon. Herein, we describe the detailed multidetector computed tomography and magnetic resonance imaging findings of a renal vein leiomyosarcoma with both extraluminal and intraluminal components in a 55-year-old woman. The intraluminal component in the renal vein, a heterogeneous enhancement caused by combined necrosis and portions of low or intermediate signal on T2-weighted images are imaging findings that suggest the diagnosis of primary leiomyosarcoma of the renal vein.

MeSH Terms

Diagnosis
Female
Humans
Leiomyosarcoma*
Magnetic Resonance Imaging*
Middle Aged
Multidetector Computed Tomography
Necrosis
Renal Veins*
Veins
Vena Cava, Inferior

Figure

• 

  Fig. 1 55-year-old woman with left, renal-vein leiomyoscarcoma. A, B. Enhanced axial CT scans obtained at the level of the pancreas uncinate process (A) and the renal hila (B) show a heterogeneous, soft-tissue, retroperitoneal mass (long arrows in A, B) in the lumen of the left renal vein with thin splaying of contast medium (short arrows in B); the mass abuts the uncinate process of the pancreas anteriorly. C. Coronal reformatted image demonstrates the extraluminal component of the tumor (long arrow) abutting the portal vein superiorly and the intraluminal component (short arrow) in the left renal vein. D-H. On axial T1-weighted MR images (D, E), the mass (arrow) appears isointense relative to the muscle (D). On T2-weighted (E, F) MR images, the extraluminal component (arrow in E) of the mass shows low signal intensity and the intraluminal component (arrow in F) appears heterogenous, although relatively iso- to hyperintense. The intraluminal component has a high-signal-intensity portion (curved arrow in F), a finding that indicates necrosis. Contrast-enhanced, fat-suppressed, T1-weighted MR images (G, H) reveal heterogenous enhancement of the mass (arrow in G, H), and a poorly enhancing portion (curved arrow in H) suggests necrosis. Splaying of the contrast medium is also noted in the left renal vein (short arrow in H). I. Microscopic examination (original magnification, × 12; H&E stain) illustrates a transition (long arrow) between the leiomyosarcoma (curved arrows) and the intima of the renal vein wall (short arrow). The findings confirm that the tumor arose from the wall of the renal vein. The lumen (asterisk) of the left renal vein is noted. J. Photomicrograph (original magnification, × 200; H&E stain) shows typical histologic features of leiomyosarcoma: interlacing fascicular pattern with nuclear atypia and mitosis, proliferating spindle-shaped cells (arrow). K. Immunohistochemical staining (original magnification, × 200) is positive for smooth muscle actin, which appears brown. Note.-Ao = abdominal aorta, IV = inferior vena cava, star = incidental hepatic cyst

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