CAVECTOMY AND NEPHRECTOMY IN MONOBLOCK TO APPROACH LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA: CASE REPORT (Atena Editora)

Abstract

With only 300 cases reported in the literature from 1871 onwards, leiomyosarcoma of the inferior vena cava continues to be classified as a very rare neoplasm. Only 2% of all leiomyosarcomas are vascular, with venous ones being five times more common. Case clinical: A 49-year-old female patient, who underwent mastectomy in 2016 and 2018 (phyllodes tumor), reports pain in the right flank, which radiated to the back and mesogastrium, which started in June 2021. CT of the abdomen and pelvis on 01/10/2022 with expansive formation, heterogeneous located in the right retroperitoneum, in the topography of the inferior vena cava and inseparable from the caudate lobe of the liver, the left renal vein and the right renal artery, measuring 5.8 x 4.5 cm. Planning: Prior venography was performed to identify vascular collateralization that would allow complete resection of the mass en bloc with the right kidney and right adrenal gland, without harming neighboring structures. After viewing the patency of the lumbar veins that supplied the left kidney in addition to the left vein (which would be sacrificed), surgery was indicated. Surgical technique: exploratory laparotomy was performed with identification of the mass adjacent to the right kidney, compatible with the inferior vena cava. Proximal and distal vascular control of the inferior vena cava was performed, the right renal and suprarenal vessels and the left renal vein were ligated. The piece was removed en bloc, with free macroscopic margins, without inserting a vascular prosthesis. During the postoperative period, the patient evolved uneventfully, with no impairment of her renal function at any time, and was discharged without any complications.