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Leiomyosarcoma is a rare tumor of mesenchymal origin usually affecting the inferior vena cava. Early diagnosis is essential before surgical resection, which is the only therapeutic modality that prolongs patients' survival. Ultrasonography, computer tomography, and magnetic resonance imaging are the main imaging modalities in this case. Combined with guided biopsies, they form the mainstay of reliable diagnosis. We report a case with retroperitoneal tumor arising from the middle segment of the inferior vena cava. Radiological examination revealed retroperitoneal tumor and helped to choose surgical treatment. Histopathological examination confirmed the diagnosis of leiomyosarcoma of the inferior vena cava.

Sarcoma of the corpus uteri should be considered as a differential diagnosis in postmenopausal women presenting with severe abdominal pain, thought to be due to degenerative changes of leiomyoma uteri. We present a rare case of leiomyosarcoma in a postmenopausal White woman. Diagnosis was missed preoperatively for degenerating uterine fibroid.

Percutaneous radiofrequency ablation (RFA) is an alternate treatment modality for pulmonary metastasis in non-surgical candidates. Four patients not suitable for surgery underwent percutaneous RFA for pulmonary metastases from leiomyosarcoma. Success of RFA was assessed with computed tomography (CT). The median length from the radiographic diagnosis of metastatic pulmonary disease (CT-scan) from the primary tumor diagnosis was 67.0 months with a range of 15.0-81.0 months. The median disease free interval following RFA was 19.0 months with a range of 4.0-35.0 months. Three of four patients underwent the procedure uneventfully. RFA is a safe and minimally invasive intervention in non-surgical candidates with sarcoma pulmonary metastases.

Uterine leiomyosarcoma metastatic to multiple cardiac chambers occurs infrequently. Over the past 4 decades, there have been only 11 reported cases of cardiac metastasis secondary to uterine leiomyosarcoma. Metastatic cardiac tumors are commonly diagnosed postmortem, although it may be possible to diagnose them during life. The authors report a rare case of a 48-year-old woman with uterine leiomyosarcoma who was diagnosed with extensive cardiac metastases (in the left atrium, right and left ventricles, pulmonary artery, and pulmonary vein). Although extensive cardiac metastases are suggestive of imminent death, aggressive treatment resulted in survival for >1 year for this patient, which underscores the importance of treatment in select patients.

Objective: Leiomyosarcoma, a malignant neoplasm of smooth muscle, accounts for 7% of the sarcomas. Patients with leiomyosarcoma tumors have an average survival of 5 years. These tumors, which are derived from mesenchymal tissues, are difficult to diagnose, and treatment options remain controversial. The relatively rare incidence of this soft tissue sarcoma subtype has limited the number of patients available for studies and research. This study examines whether the imaging characteristics of positron emission tomography (PET) with radiolabeled fluorodeoxyglucose (FDG) provide a reliable, noninvasive means to predict tumor behavior in patients with leiomyosarcomas., Methods: [18F]-FDG-PET was performed on the tumors of participating patients before the neoadjuvant chemotherapy or resection, and a maximum tumor standard uptake value (SUVmax) was calculated., Results: The SUVmax was correlated with tumor grade (P=0.001) and tumor size as greatest dimension (P=0.004). Analysis of these data indicated the potential effectiveness of FDG-PET imaging in predicting tumor grade., Conclusion: In leiomyosarcoma, the SUVmax from FDG-PET is a likely predictor of tumor behavior. The results of this study suggest that a large (by greatest dimension) intermediate grade tumor is expected to have the same predicted outcome as a high-grade tumor and should be treated in the same manner, as they share the same prognosis by definition of tumor grade. Improvements made in the clinical treatment of leiomyosarcomas by use of FDG-PET imaging data may lead to an increase in patient survival.

Reported herein is a gastric leiomyosarcoma, which, nowadays, is extremely rare. Attention was focused not only on pathological findings but also on the histological basis of magnetic resonance imaging (MRI) findings. The patient was a 29-year-old Japanese woman. Preoperative T2-weighted MRI showed a large high-intensity gastric tumor with isointense streaks. The tumor was a broad-based large polypoid lesion and histologically consisted of fascicles of spindled cells having eosinophilic cytoplasm and cigar-shaped nuclei. Immunoreactivity for several smooth muscle markers including desmin on tumor cells, low amplification of both c-kit and PDGFRA cDNA on polymerase chain reaction, and absence of c-kit gene mutation in exons 9 and 11 strongly suggested that the tumor was not a gastrointestinal stromal tumor but a true leiomyosarcoma. In vitro MRI of the fresh tumor was obtained to explain the radiological findings on a morphological basis. In vitro MRI clearly depicted the very high-intensity areas separated by radially extended isointense lines. This radiological finding corresponded best to the most characteristic histological feature, that is, linearly extended fascicles of the tumor cells often with myxedematous change separated by radially elongated thin fibrovascular stroma: in other words, spouting appearance.

Objective: To summarize the imaging features of nonepithelial tumors of the bladder., Methods: The Imaging findings in 20 surgically treated patients with pathologically proved nonepithelial tumors of the bladder were retrospectively analyzed. The tumors included leiomyoma (n = 9), pheochromocytoma (n = 6), leiomyosarcoma (n = 2), rhabdomyosarcoma (n = 1), carcinosarcoma (n = 1), inflammatory myofibroblastoma (n = 1)., Results: The leiomyomas were round or ellipse in shape with a sharp border and homogeneous density, and showed a low signal intensity on T1WI and T2WI in 1/1 case; slight enhancement on CT after contrast enhancement in 6/7 cases; and a poor blood supply on color Doppler ultrasonography in 3/4 cases. The pheochromocytoma had a round or oval shape and clear border, and slightly lobulated in 4/6 cases, homogeneous density/echo/signal in 5/6 cases, calcification in 1 case, low signal intensity on T1WI and high signal intensity on T2WI in 1/1 case, moderate or marked enhancement on CT and MRI in 4/5 cases, and strong blood supply on color Doppler ultrasonography in 3/4 cases. The inflammatory myofibroblastoma showed the same imaging features as the pheochromocytomas. Other malignant tumors showed an irregular configuration, with a poorly defined border, heterogeneous density/echo/signal and moderate to strong enhancement on CT., Conclusion: Most leiomyomas and pheochromocytomas of the bladder show some typical imaging features on CT, MRI and ultrasound, which are helpful in making correct diagnosis and treatment plan preoperatively. Other malignant nonepithelial bladder tumors do not show special imaging characteristics and can only be diagnosed qualitatively.

The case of a 42-year-old woman with leiomyosarcoma of the kidney, a very rare renal lesion, is presented. Leiomyosarcomas are the most common of the primary renal sarcomas which account for less than 1% of renal tumours in adults.

Aim: To describe the imaging features and the correlation with clinical findings of adult prostate sarcoma., Materials and Methods: Radiological data of seven adult male patients with prostate sarcoma, documented by pathological examination of specimens, were analysed retrospectively. Radiological features were correlated with clinical and pathological findings., Results: The mean age of the study population was 45.8 years (range 21-76 years). The mean value of the serum prostate specific antigen (PSA) in seven patients was 1.59 ng/ml (range 0.735-3.72 ng/ml). Five patients had leiomyosarcomas and two had rhabdomyosarcomas. The most common symptom was urinary obstruction (n=7) and the most common sign was the markedly enlarged prostate as revealed by digital rectal examination (n=7). The mean size of the tumours was 8.7 x 7.2 x 7 cm (range 6.5 x 5x 6.5 to 12.1 x 10.2 x 8.9 cm). Tumours were round (n=4), lobular (n=2), or irregular (n=1). Two tumours occupied the majority of the prostate and five occupied the entire prostate. One tumour appeared as a homogeneous mass, and six tumours contained cystic areas on computed tomography (CT) and magnetic resonance imaging (MRI). Tumours enhanced avidly on contrast-enhanced CT (n=5) and MRI (n=2). Magnetic resonance spectroscopy (MRS; n=2) showed the ratio of choline:citrate to be 1.6 and 10.75. Tumour invasion was present in the bladder (n=3) and rectum (n=1)., Conclusions: Adult prostate sarcoma was characteristically shown to be a large and heterogeneous mass with rapid, hypervascular and heterogeneous enhancement on CT and MRI. The main MRS feature was a marked increase in the choline:citrate ratio. The clinical manifestations corresponded mainly to local mass effects and tumour invasion.

Leiomyosarcomas are rare malignant mesenchymal tumors. We report the case of a 55-year-old man with a lung metastasis from an iliofemoral leiomyosarcoma mimicking a deep venous thrombosis (DVT). Vascular leiomyosarcoma occurs in the wall of large vessels, and usually presents as unexplained DVT. To date, few cases of peripheral leiomyosarcomas have been described in the literature. This observation demonstrates the usefulness of Positron Emission Tomography (PET), beyond oncologic staging, in such indications as the workup of an unexplained DVT. In this report, PET prevented a misdiagnosis of DVT by showing a peculiar cockade appearance of the vessel. Compared with conventional imaging, PET can provide complementary information. The specificity of such information still needs to be assessed.

It is uncommon for patients to present with bone metastases while the primary tumor is still unknown. The case of a patient with bone metastases as primary presentation of leiomyosarcoma, who was diagnosed after a 18F-FDG PET-CT and a CT-guided biopsy of the adrenal gland is described. If after routine physical, laboratory and radiological investigations no diagnosis can be made, 18F-FDG PET should be added to the conventional work-up of patients with unknown primary cancer. In this way, unnecessary and enduring suffering of symptomatic patients may be prevented.

Introduction: Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure. Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not well defined., Methods: We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical presentations, operative techniques, patterns of recurrence and survival., Results: From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40-76). Presentations included abdominal pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection margins were negative in seven cases. Median length of stay was 12 days (range, 6-22 days). Major morbidity included renal failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation. Median survival was 47 months (range, 1-181 months). Four patients had recurrence and the median time to recurrence was 14 months (range, 3-25 months). Two patients underwent successful resection of recurrence., Conclusions: Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered.

Leiomyosarcoma of adrenal gland is an extremely rare tumor originating from the central adrenal vein or its tributaries. Patients with human immunodeficiency virus (HIV) and Epstein-Barr infection have a higher incidence of these tumors, but even in those, the overall incidence is very low. In this paper we report a case of a 48 year-old woman whose diagnosis was made by image exams that had suggested a mass in adrenal area. This patient was submitted to surgery for resection of the mass. The histopathologic and immunohistochemistry exams were compatible with primary leiomyosarcoma of adrenal gland. Fifty-three months after adrenalectomy the patient died with recurrent disease. Despite of the rarity of this tumor, leiomyosarcoma of adrenal gland has an aggressive behavior, such as the others soft tissue sarcomas. The adrenalectomy is the primary treatment, while chemotherapy or radiotherapy is not prescribed except in metastatic or bulky and inoperable disease.

Retroperitoneal leiomyosarcomas account for <1% of all tumors diagnosed in the U.S. They are usually unresectable at the time of diagnosis due to their vague clinical presentation. Aortic rupture from tumor invasion by retroperitoneal leiomyosarcomas is extremely rare and has only been described in one case report. We describe a case of an unresectable retroperitoneal leiomyosarcoma eroding into the infrarenal abdominal aorta resulting in an acute contained intratumoral hemorrhage successfully treated with a percutaneous placed abdominal aortic endograft. This article discusses the endovascular treatment of this rare medical emergency performed quickly and effectively in our endovascular suite. Endovascular specialists should be familiar with this lifesaving endovascular option in the setting of an acute aortic rupture.

Leiomyosarcomas of the ovarian vein are very rare. Four cases have been reported in the English language clinical literature. We present a case of leiomyosarcomas where the use of multi-detector CT had a substantial role in the establishment of the preoperative diagnosis. The radiological images as well as intraoperative features are illustrated. We also discuss the radiological findings of the ovarian vein leiomyosarcoma in comparison with those of other venous or retroperitoneal leiomyosarcomas. We expect that the use of multi-detector CT will be the choice for the diagnostic work-up of vascular leiomyosarcomas.

Aim: Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor that frequently produces non-specific symptoms. Surgical treatment is complex. In this review of our experience, we highlight replacement modalities of the vena cava or other vessels after complete tumor resection., Methods: During the last 20 years, we treated 12 patients (6 women and 6 men; age range, 38-72 years) with IVC leiomyosarcoma, all apparently free of distant metastases. Tumor location, graft patency, long-term survival and tumor recurrence were recorded. The tumor arose from the IVC in 8 patients; in 2 cases the intracaval mass reached the right atrium; in 4 patients the tumor arose from the femoroiliac axis. Surgical approach was by sternolaparotomy in 5 cases and by median xyphopubic access in 7. Extracorporeal circulation (ECC) was needed in 2 cases. All tumors were removed by en bloc resection. The IVC was directly sutured in 2 patients and patched in 4; no reconstruction was necessary in 2 patients; the IVC was replaced in the remaining cases. Four patients had an additional arteriovenous fistula. One patient underwent bifurcated Dacron graft replacement of the aortic carrefour involved by tumor., Results: Two patients died postoperatively. One patient developed late stenosis of the polytetrafluoroethylene (PTFE) graft, which was treated by stenting. The mean follow-up period was 35 months. The 4-year survival rate was 51% and survival free of recurrence was 63%., Conclusion: Leiomyosarcoma of the IVC is an uncommon tumor that produces non-specific symptoms. In the absence of distant malignancy, an aggressive approach can obtain late survival free of recurrence.

Endobronchial leiomyosarcoma is an unusual tumor of the respiratory tract. Clinically, patients may present with intermittent coughing, chest pain, dyspnea, hemoptysis, and fever until late in the course of the disease because of total obstruction of the main airway. In this paper, we report the case of a 51-year-old male with endobronchial leiomyosarcoma who presented with acute respiratory distress as a result of total obstruction of the right main bronchus and suffocation after massive hemoptysis. After intraoperative bronchoscopic assessment and bronchotomy, an elongated endobronchial tumor was found that arose from the right middle lobe (RML) bronchus with intraluminal extension upward into the right main bronchus. He underwent RML and right lower lobe (RLL) bilobectomy and had a rapid and uneventful recovery.

We describe an adult patient with a primary left atrial leiomyosarcoma in whom live/real time three-dimensional transthoracic echocardiography showed echolucent areas within the mass consistent with necrosis or hemorrhage surrounded by dense band-like echo densities indicative of fibrosis or collagen giving a "doughnut" like appearance. These findings were consistent with histopathology, which showed areas of necrosis and dilated vascular channels within the fibrotic tumor. Our case further illustrates the usefulness of three-dimensional transthoracic echocardiography in characterizing the morphologic features of an intracardiac mass.

We report a case of a 44-year-old woman who had coexisting distinct and separate primary tumors of the bladder: a leiomyosarcoma and a transitional cell carcinoma (urothelial cancer). The patient presented with macroscopic hematuria. A computed tomography scan of the pelvis showed a bladder mass along the left anterolateral wall. A transurethral resection of the bladder was performed. A pathological examination revealed that the mass was leiomyosarcoma. The patient underwent radical cystectomy with ileal conduit diversion. The urinary cystectomy specimen revealed an 11 cm x 6 cm x 5 cm solid mass on the left anterolateral wall and two 1-cm papillary tumors with different localization on the right and left lateral walls of the urinary bladder. Pathological examination revealed that the masses were high-grade leiomyosarcoma and urothelial cancer. Because of the differences in the histogenesis and prognosis, such cases should be differentiated from cases of carcinosarcoma of the urinary bladder. Synchronous occurrence of urothelial cancer and sarcoma as two separate primary tumors in the bladder is very rare. To our knowledge, seven cases of coexisting sarcoma and transitional cell carcinoma of the urinary bladder have been reported in the literature.

The authors present a case of a 42-year-old female who developed a leiomyosarcoma of the right proximal tibia that appeared radiologically similar to a giant cell tumor Histology revealed spindle cells running in whorl-like fashion with focal atypia and low mitotic figures. The immuno-stains revealed positive reactivity for alpha-smooth muscle (SMA), muscle actin and cytokeratin (AE1/AE3). The authors rendered a diagnosis of low-grade leiomyosarcoma of bone. The lesion was considered a primary lesion since the patient did not have other leiomyomatous tumors. The MRI showed hypo- to iso- signal intensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging. This was likely due to admixed fibrotic tissue in the lesion. The tumor cells were not positive for Ebstein-Barr virus by in-situ hybridization as seen in leiomyomatous tumors in immunodeficiency patients.

Purpose: Change in tumor size as classified by Response Evaluation Criteria in Solid Tumors poorly correlates with histopathologic response to neoadjuvant therapy in patients with soft-tissue sarcomas. The aim of this study was to prospectively evaluate whether positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) allows for a more accurate evaluation of histopathologic response., Experimental Design: From January 2005 to January 2007, 42 patients with resectable biopsy-proven high-grade soft-tissue sarcoma underwent a FDG-PET/computed tomography scan before and after neoadjuvant treatment. Relative changes in tumor FDG uptake and size from the baseline to the follow-up scan were calculated, and their accuracy for assessment of histopathologic response was compared by receiver operating characteristic curve analysis. Histopathologic response was defined as > or =95% tumor necrosis., Results: In histopathologic responders (n = 8; 19%), reduction in tumor FDG uptake was significantly greater than in nonresponders (P < 0.001), whereas no significant differences were found for tumor size (P = 0.24). The area under the receiver operating characteristic curve for metabolic changes was 0.93, but only 0.60 for size changes (P = 0.004). Using a 60% decrease in tumor FDG uptake as a threshold resulted in a sensitivity of 100% and a specificity of 71% for assessment of histopathologic response, whereas Response Evaluation Criteria in Solid Tumors showed a sensitivity of 25% and a specificity of 100%., Conclusion: Quantitative FDG-PET was significantly more accurate than size-based criteria at assessing histopathologic response to neoadjuvant therapy. FDG-PET should be considered as a modality to monitor treatment response in patients with high-grade soft-tissue sarcoma.

Cardiac leiomyosarcomas are rare and highly invasive malignant tumors. We report a 29-year-old female with mitral stenosis symptomatology due to a left atrial leiomyosarcoma invading mitral anterior leaflet.

Leiomyosarcomas are unusual soft-tissue tumours that occur in the retroperitoneum, peripheral soft tissues, gastrointestinal and genito-urinary tracts, vessels and (rarely) in bone. The aim of this pictonal review is to delineate the more specific radiological features that would suggest a radiological diagnosis of leiomyosarcoma prior to biopsy.

A case of retroperitoneal leiomyosarcoma (LMS) in a 38-year-old woman who had a tumor in the retroperitoneum with severe hypertension and hypokalemia is presented. Further investigation revealed an elevated serum aldosterone and norepinephrine level. After tumorectomy, the levels of serum aldosterone and norepinephrine successfully normalized; hypertension and hypokalemia were also cured. The tumor was diagnosed as being a LMS by pathologic examination. We suggested that this was the first case of retroperitoneal LMS shown to be associated with increased levels of serum aldosterone and norepinephrine., (2008 S. Karger AG, Basel)

Purpose: To evaluate the role of gray-scale and color Doppler sonography to distinguish uterine leiomyosarcoma (LMS) from leiomyoma (LM)., Methods: We analyzed the preoperative gray-scale and color Doppler sonographic findings of 8 patients with LMS, 21 patients with cellular leiomyomas, and 3 patients with smooth muscle tumors of uncertain malignant potential and compared these findings to 225 patients with benign LM. All patients underwent myomectomy or hysterectomy. Number, size, echotexture, degenerative changes, and vascularity (central or peripheral; absent, mild, moderate, or marked) were recorded and correlated to the histologic findings, Results: LMSs were significantly larger than other uterine smooth muscle tumors. They were all solitary, and 7/8 lesions had a diameter >or=8 cm. Degenerative cystic changes were observed in 4 lesions, and increased peripheral and central vascularity was demonstrated in 7 lesions. Sensitivity, specificity, and positive predictive value of increased central and peripheral vascularity in the diagnosis of LMS were 100%, 86%, and 19%, respectively. Combining other sonographic findings with marked central vascularity, positive predictive value increased to 60%, but sensitivity decreased to 75%., Conclusion: The findings of the present study suggest that the detection of hypervascularity in combination with other sonographic findings can identify suspicious uterine smooth muscle tumors that will require additional diagnostic evaluation before treatment., ((c) 2007 Wiley Periodicals, Inc.)

Primary vascular leiomyosarcoma is a rare tumor, which arises mainly from the inferior vena cava. Clinical signs are non-specific. Systemic metastasis occurs in the late stage. Imaging with color Doppler ultrasonography, contrast-enhanced computed tomography, or magnetic resonance imaging can significantly contribute to the diagnosis. We present a case of leiomyosarcoma of the inferior vena cava that extended into the right renal vein and the right iliac vein, as it is a rare case and emphasize the significance of the imaging methods in its diagnosis.

Radiation-induced neoplasm including meningioma, glioma and sarcoma, is an uncommon but known consequence after therapeutic irradiation of pituitary tumour. Radiation-induced leiomyosarcoma due to previous sellar irradiation has only been reported once in the literature. We herein present the second case of radiation-induced leiomyosarcoma that happened 17 years after radiation therapy for pituitary adenoma. The case is unique in its initial presentation, i.e. acute intracerebral haemorrhage. To the best of our knowledge, such an acute and severe presentation has never been reported in radiation-induced neoplasm following radiotherapy for pituitary adenoma.

Sarcomas are rare neoplasms, accounting for a 1.7% incidence among all transplanted patients presenting with de novo malignancies. Our present report focused on a 46-year-old woman who received immunosuppressive therapy based on cyclosporine and steroids for renal transplantation. Eight years after transplantations, she suffered lower abdominal pain and a mass involving peritoneal soft tissues was located near the right iliac vessels. Upon radical tumor excision, the histological examination revealed a high-grade leiomyosarcoma. Immunosuppression was reduced and cyclosporine switched to rapamycin. After 30 days, a computed tomography scan revealed two small pulmonary metastases, so the patient received adriamycin. Six months after the diagnosis, there was no intra-abdominal relapse and the pulmonary metastasis remain stable. The function of the transplanted kidney was normal and the patient was listed for laparoscopic pulmonary resection. Sarcomas in solid organ transplant patients appear to have aggressive features with 62% being high grade and 40% metastatic at the time of primary diagnosis with a recurrence rate of 30% and a 5-year survival rate of 25%. Patients diagnosed with sarcoma should be treated with multimodality therapy. After aggressive surgery whenever possible, a combination of a traditional cytotoxic drug and a "signal" blocking agent like rapamycin may increase selectivity toward tumor cells.

Objective: Describe our experience with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with uterine sarcomas, under suspicion of recurrence and in tumour staging after hysterectomy as an incidental pathology finding., Material and Methods: A retrospective review, between april 2002 and january 2006, of FDG-PET performed in 10 patients with clinical diagnosis of uterine sarcoma was made (7 patients under recurrence suspicion and three under initial staging). Mean age was 52.2 yrs. Evolution time after initial diagnosis vary from one month to 15 yrs (median time: 14 months). Lesions were classified as 8 leiomyosarcomas and 2 carcinosarcomas. FIGO staging were establish resulting 5 patients stage I, 1 patient stage III, and 4 patients stage IV., Results: 4 of 7 patients under suspicion of recurrence showed discrepancies between positron emission tomography (PET) and conventional imaging techniques (CIT) information. FDG-PET was negative in three cases of non-conclusive CT. PET was negative in one case with pulmonary metastases. The 3 staging studies were concordant both FDG-PET and CIT images. Pathological information was obtained in 5 cases, and a mean time of 14 months of clinical follow up was made., Conclusions: FDG-PET can be useful in the follow up of uterine sarcoma patients, and also when it is an incidental finding in other causes hysterectomy.

Background: Leiomyosarcoma is a malignant neoplasm and can originate within major abdominal veins, including the inferior venacava (IVC)., Case: A 45-year-old woman presented with upper abdominal pain and a mass lesion in the liver and within the lumen of the IVC. A diagnosis of primary leiomyosarcoma of the IVC was made by using imaging techniques,fine needle aspiration cytology and histopathologic examination of the resected specimen., Conclusion: In patients presenting with vague upper abdominal pain and radiologic features of a hepatic mass extending to major veins, the rare possibility of primary leiomyosarcoma of the IVC shoald he considered and investigated by both fine needle aspiration cytology and intraoperative histology. Early surgical intervention and/or postoperative chemotherapy and radiotherapy are associated with improved survival.

Leiomyosarcomas of the inferior vena cava are rare and the clinical symptoms unspecific. We report a case of leiomyosarcoma of the inferior vena cava in an 82-year-old woman presenting with weight loss and abdominal pain. Following elaborate preoperative examinations, surgical resection was performed and the inferior vena cava was reconstructed. Clinical signs, diagnosis, therapy, and prognosis are discussed.

Aims: The prognosis for patients with advanced tumors invading the inferior vena cava (IVC) is dismal and surgical treatments for these tumors are challenging. A surgical approach that avoids sternotomy and thoracotomy for tumors invading the IVC even to the level of the hepatocaval junction would be extremely helpful., Methods: The intrapericardial IVC was isolated via a transdiaphragmatic pericardial window using a transabdominal approach. Hepatectomy was then applied via an anterior approach until the IVC was seen. Total hepatic vascular exclusion was achieved by clamping the portal triad, intrapericardial IVC and infrahepatic IVC. We removed the primary tumor, the liver portion involved and the tumor thrombi, with segmental resection of the IVC. Vascular continuity was reestablished using a 20-mm-diameter polytetrafluoroethylene graft., Results: Four patients with tumors invading the IVC were treated with this method. All underwent gross en-bloc tumor resections and all survived., Conclusion: This method for the resection of IVC tumors could avoid emboli dislodging from the tumor thrombi, prevent the complications of sternotomy, cardiopulmonary bypass and shorten operative times.

Background: Prolonged treatment with antiprogestin results in shrinkage of benign uterine leiomyomata. Leiomyomata and uterine leiomyosarcomas share some common features, and they both often express progesterone receptors. Thus, treatment of uterine leiomyosarcomas with antiprogestins has been suggested., Cases: The antiprogestin mifepristone was administered (50-200 mg/d) to three patients with recurrent uterine leiomyosarcomas. A dramatic response lasting more than 3 years was observed in a case of recurrent low-grade (G1) progesterone receptor-positive leiomyosarcomas. In two other patients, with G3 leiomyosarcomas, the disease progressed despite several months of mifepristone therapy., Conclusion: We speculate that mifepristone has a role in the management of some cases of recurrent uterine leiomyosarcomas.

Sarcomas represent 1-2% of all malignant renal tumors in adults, with an incidence that increases with advancing age. Renal sarcoma is less common, but more lethal than sarcoma of any other genitourinary site. The common signs and symptoms associated with renal sarcoma in adults include palpable mass, abdominal or flank pain and hematuria similar to those seen with large, rapidly growing renal cell carcinomas. Usually, radical nephrectomy remains the treatment of choice for these tumors, which exhibits an aggressive biological behavior and an unfavorable prognosis. We describe an unusual case of renal leiomyosarcoma that underwent nephron sparing surgery, in a 55-year-old white woman, who had a renal mass for 3 years. The size of the renal mass did not change during this period and no distant metastasis occurred. The patient is still alive without any symptoms of relapse.

Primary venous leiomyosarcoma is rare. We report the case of a primary leiomyosarcoma of the left innominate vein, with neoplastic thrombus extending into the left jugular and subclavian veins. The tumor was curatively resected en bloc with anterior mediastinal and laterocervical lymphatics, through a median sternotomy prolonged into left cervicotomy. Primary venous sarcomas may be associated with prolonged survival in individual cases, with curative resection recommended as the standard treatment, in the absence of distant spread.

Background: This study investigated computed tomographic (CT) features and anatomic bases of gastrocolic ligament involvement in malignant neoplasms of the stomach., Methods: We retrospectively reviewed CT scans of 34 patients known to have gastric malignant neoplasm and gastrocolic ligament involvement. Emphasis was placed on direct invasion, lymph node metastasis, and omental seeding., Results: CT manifestations of gastrocolic ligament involvement included direct invasion (38.2%, 13 of 34), enlargement of lymph nodes (50%, 17 of 34), "smudged" appearance (26.5%, nine of 34), "omental caking" (5.9%, two of 34), cystic mass (2.9%, one of 34), and varices of the omentum (2.9%, one of 34). We also found that gastric carcinoma and gastrointestinal stromal tumor invaded the transverse colon through the gastrocolic ligament in six patients (17.6%, six of 34)., Conclusion: CT scan is useful for detecting gastrocolic ligament involvement in gastric malignant neoplasm. The imaging features consist of a mass sign, enlargement of lymph nodes, smudged appearance, omental caking, and so on. Gastric malignant neoplasm also may involve the transverse colon through the gastrocolic ligament.