Dyspnea due to an uncommon vascular tumor: leiomyosarcoma of the infrahepatic vena cava inferior

Figures

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  Fig. 1. CT scan demonstrating a lesion (41.7 × 30.1 × 57.8 mm) with IVC infiltration and thrombus within the IVC (white arrows). a Axial. b Coronal. c Sagittal

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  Fig. 2. PET-CT scan demonstrating an infrarenal located, glucose hypermetabolic mass without evidence of distant metastases (white arrow)

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  Fig. 3. Intraoperative situs. a Presentation of the IVC after Cattell maneuver (blue vessel loops on the proximal side infrarenal and on the distal side prebifurcation, yellow vessel loop for isolation of the right ureter). b Situs after en-bloc tumor resection between Satinsky vena clamps. c IVC-reconstruction using a 20-mm PTFE vascular graft

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  Fig. 4. Intraluminal part of the mass with thrombotic material (Tr) adherent to the cranial end of the lesion

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  Fig. 5. Histopathological findings. All staining was carried out on formalin-fixed paraffin-embedded (FFPE) tissue. a Monoclonal antibodies to the Ki67 antigen (Anti-Ki67) were applied to flag cells in the G1, S, G2, and M phase of their cell cycle, but not in the resting phase G0. Despite the fact that intraobserver and interobserver reproducibility of the visual assessment of Ki67 expression in IHC are low [12], there was a consensus that the tumor showed considerable activity. b The tumor cells revealed a specific, strong, and diffuse cytoplasmatic reactivity for antibodies to smooth muscle actin (Anti-α-Actin) as seen in cases of LMS. c The cytoplasmatic reactivity of tumor cells with antibodies to desmin (Anti-Desmin) as shown here might be associated with improved survival as the expression of this antigen can help predict the outcome by segregating moderately differentiated LMS into two groups, those that behave like well-differentiated tumors by expressing desmin and those that behave like poorly differentiated tumors by not expressing it [13]. d Hematoxylin and Eosin (H&E) staining revealed tumor cells with pleomorphic nuclei and eosinophilic cytoplasmata