Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.0077
Jornal Vascular Brasileiro
Case Report

Leiomyosarcoma of the great saphenous vein

Leiomiossarcoma de veia safena magna

Alexandre Campos Moraes Amato; Ana Júlia de Deus Silva; Ricardo Virgínio dos Santos; Salvador José de Toledo Arruda Amato

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Abstract

A 56-year-old male patient presented with a complaint of two painful, hard, palpable nodules in the right lower limb. A Doppler ultrasound scan revealed the presence of nodules, likely to be neoplastic. Computed angiography showed two solid hypervascular nodules in the right great saphenous vein, fed by branches of the posterior tibial artery. Embolization of the nodules using surgical cyanoacrylate was performed, followed by an excisional biopsy. Anatomical pathology and immunohistochemical analysis identified the nodule as a high-grade leiomyosarcoma, characterized by ten mitotic figures per ten high-power fields, necrosis and cell pleomorphism. Immunohistochemical analysis results were positive for caldesmon and desmin labeling. A second surgical procedure was performed to enlarge the free margins.

Keywords

neoplasms, vascular tissue neoplasms, blood vessels

Resumo

Paciente do sexo masculino, 56 anos, com queixa de dois nódulos palpáveis, dolorosos e rígidos, em membro inferior direito. O eco-Doppler colorido evidenciou nódulos de provável natureza neoplásica na veia safena magna direita distal, com fluxo de baixa velocidade no seu interior. A angiotomografia evidenciou dois nódulos sólidos hipervascularizados no trajeto da veia safena magna direita, possuindo ramos nutridores provenientes da artéria tibial posterior. Para realizar a biópsia excisional dos nódulos, optou-se inicialmente pela embolização do tumor com cola cirúrgica de cianoacrilato, devido à sua alta vascularização. Os exames anatomopatológico e imuno-histoquímico evidenciaram leiomiossarcoma de alto grau, com dez mitoses por dez campos de grande aumento, necrose tumoral e pleomorfismo celular. A imuno-histoquímica demonstrou positividade para os marcadores Caldesmon (anticorpo hCD) e Desmina (anticorpo D33). O paciente realizou uma nova cirurgia para ampliação de margens comprometidas e está em acompanhamento clínico com a Oncologia.

Palavras-chave

neoplasias, neoplasias de tecido vascular, vasos sanguíneos

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