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CC BY 4.0 · Endoscopy 2025; 57(S 01): E183-E184
DOI: 10.1055/a-2534-3191
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Contrast-enhanced endoscopic ultrasonography for diagnosis of leiomyosarcoma of the inferior vena cava

Wen Zhang 
1   Department of Gastroenterology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
2   Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
,
Ming-Yan Cai 
2   Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
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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]).

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Fig. 1 Contrast-enhanced computed tomography scan showed a mass of approximately 7 cm in diameter in the right retroperitoneum.

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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).

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Fig. 2 Endoscopic ultrasound showed a 7-cm hypoechoic mass originating from the inferior vena cava.
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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.

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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.

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Artikel online veröffentlicht:
20. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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