Endoscopic ultrasound (EUS) has become an important diagnostic tool for various diseases
[1]. Contrast-enhanced (CE)-EUS has emerged as an effective technique that is complementary
to conventional EUS and allows visualization of microvessels and parenchymal perfusion,
and more accurate characterization of the lesion [2].
We report the case of a 46-year-old woman with abdominal pain. On a contrast-enhanced
computed tomography scan, a mass of approximately 7 cm in diameter was discovered
in the right posterior peritoneum, with compression of the duodenum and inferior vena
cava (IVC) ([Fig. 1]). We decided to perform CE-EUS for this patient ([Video 1]).
Fig. 1 Contrast-enhanced computed tomography scan showed a mass of approximately 7 cm in
diameter in the right retroperitoneum.
Contrast-enhanced endoscopic ultrasonography for diagnosis of leiomyosarcoma of the
inferior vena cava.Video 1
On CE-EUS, we discovered a solid hypoechoic lesion originating from the IVC wall,
independent of the duodenum ([Fig. 2]). After injection of contrast reagent (Sonovue; Bracco, Milan, Italy), the lesion
showed heterogeneous hyper-enhancement into the lesion ([Fig. 3]). For a pathological diagnosis, EUS-guided fine-needle aspiration (EUS-FNA) of the
lesion was performed with a 22-gauge needle (SharkCore; Medtronic, Minneapolis, Minnesota,
USA).
Fig. 2 Endoscopic ultrasound showed a 7-cm hypoechoic mass originating from the inferior
vena cava.
Fig. 3 Contrast-enhanced endoscopic ultrasonography showed a heterogeneous hyper-enhancing
pattern into the lesion.
Histological examination revealed an abnormal high proliferation of spindle cells,
obvious nuclear atypia, and mitotic activity. The immunohistochemical stains revealed
positivity for B-cat, EMA, and SMA, and negativity for CD34, CD117, CgA, S100, SOX11,
and SYN ([Fig. 4]). We suspected a malignant spindle cell tumor originating from the IVC, most compatible
with leiomyosarcoma. The patient accepted surgical resection and vascular reconstruction.
Fig. 4 Histopathology of tissue mass samples by endoscopic ultrasound-guided fine-needle
aspiration. a Original magnification of hematoxylin and eosin stain (×5). b Local magnification showed large areas of spindle cells (×200). c Tumor cells showed diffuse SMA expression (×200). d Tumor cells showed negativity for CD34 (×200).
Finally, the specimen confirmed the diagnosis of leiomyosarcoma. Immunostains showed
diffuse positivity for caldesmon, calponin, desmin, EMA, and SMA but negativity for
CD10, CD34, CD117, Muc-4, S100, and STAT6.
Primary leiomyosarcoma of the IVC is a rare soft tissue sarcoma [3]. This is the first instance where CE-EUS was applied in the preoperative diagnosis
of
IVC leiomyosarcoma. The essential role of CE-EUS and EUS-FNA in evaluating IVC leiomyosarcoma
preoperatively is remarkable.
Endoscopy_UCTN_Code_CCL_1AF_2AG_3AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
