Presentation
Hard, palpable mass in the left flank and abdominal pain for 1 month. Her history included an ovariohysterectomy 10 years earlier for the nonmalignant disease.
Patient Data
US shows the vascular structure, filled with solid components, connected to left vein renal and main mass
This mass is loculated, well-defined lobulated, heterogenicity comparable to fibroid with intravascular growth patterns.
The tubular structure with an enhancing wall and low-attenuation thrombus in the expected location of the left ovarian vein of which a huge mass arising from the retroperitoneal space along the course. This mass is well-defined lobulated with highly enhanced solid components and low-attenuation areas representing necrosis. The tortuous arteries are also seen within the tumor.
The left ureter is next to mass and no left hydroureteronephrosis ( No delayed phase )
There were no ascites, lymphadenopathy or peritoneal metastasis
The patient didn't agree with the surgical.
Case Discussion
Leiomyosarcomas of the vein are an unusual type of tumor. The inferior vena cava is the commonest site of this lesion in the venous system and the ovarian vein is an extremely rare affected vessel. Only a few cases of LMS arising from the ovarian vein have been reported in the literature. The prognosis for patients is very poor due to the high metastatic potential by hematogenous spread.
This case has a differential diagnosis of a retroperitoneal tumor that could be either a malignant lymphoma, leiomyoma, or gastrointestinal stromal tumor.
However, the CT scan identified a retroperitoneal mass along with the anatomical site of the left ovarian vein with typical radiological features of a gonadal vein leiomyosarcoma which were described in previous literature, hence suggestive of the diagnosis of ovarian vein LMS