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a, b: An abdominal CT with contrast enhancement reveals an 8-cm tumor in the main trunk of the portal vein, and portal venous collaterals are well-developed (arrow) (a: axial view, b: coronal view). c, d: An endoscopic US shows the tumor located in the portal vein, from confluence of the superior mesenteric vein and the splenic vein to bifurcation, concomitant with portal venous obstruction. PV: portal vein, SPV: splenic vein, SMV: superior mesenteric vein
Source publication
We report a case of a 62-year-old woman having leiomyosarcoma of portal vein origin. A large intra-abdominal tumor was detected in the hepatoduodenal ligament using CT in the asymptomatic patient. The tumor was 8 cm in diameter and originated from the portal vein trunk with complete obstruction causing development of the collateral veins. Total exc...
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Citations
We encountered a rare case of a pancreatic head tumor protruding into the portal vein, later diagnosed histopathologically as primary leiomyosarcoma of the portal vein. A 59-year-old woman visited our hospital because of an elevated amylase level during a medical checkup. Computed tomography showed a moderately contrasted, well-defined mass of 35-mm diameter in the pancreatic head with protrusion into the portal vein. Endoscopic ultrasonography revealed a well-defined and hypoechoic mass. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the pancreas head. We performed a subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection. Gross findings of the fixed specimen showed a white solid, multinodular mass in the pancreatic parenchyma with protrusion into the portal vein. Histopathological examination showed proliferation of spindle-shaped eosinophilic cells with intricate bundle-like growth, indicating leiomyosarcoma. Examining the tumor location and invasion suggested portal vein as the origin. Although portal vein primary leiomyosarcoma is rare, leiomyosarcoma should be considered as a differential diagnosis in pancreatic head tumors with protrusion into the portal vein. Precise macroscopic and histopathological examinations can help determine the definitive diagnosis and origin of leiomyosarcoma.
