RESUMO
BACKGROUND: Primary leiomyosarcoma (LMS) of the hepatic vena cava is a rare malignancy that has only been published in case reports. Only a few cases with successful R0 resection have been reported in the literature. METHODS: We report 2 similar cases of extended primary LMS of the intrahepatic inferior vena cava (IVC). Both patients previously underwent operations in nonspecialized centers that resulted in inadequate tumor resection. After admission to a high-volume center focusing on the treatment of patients with sarcoma, R0 resection was feasible with a multimodal therapeutic treatment approach. RESULTS: Radical complete tumor resection was achieved by means of extended right-sided hemihepatectomy (segments V-VIII and I), en bloc resection, and prosthetic replacement of the IVC and nephrectomy in 1 patient. Both patients are currently tumor-free and healthy 6 months postoperatively. CONCLUSIONS: Patients with such complex tumors should be referred to centers with specialized surgeons who can preoperatively estimate whether complete resection may be possible and who are capable of performing such delicate interventions.
Assuntos
Hepatectomia/métodos , Leiomiossarcoma/cirurgia , Neoplasias Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior , Adulto , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/diagnósticoRESUMO
In brief Sports medicine physicians see brief overuse, chronic, or recurrent injuries in athletes every day. However, some patients who have symptoms consistent with these injuries actually have underlying disease. Three case studies examine athletes who initially seemed to have overuse syndromes or recurrent chronic injuries. The eventual diagnoses were rheumatoid arthritis, systemic lupus erythematosus, and gout.