Liver transplantation for inferior vena cava leiomyosarcoma: from a Maslow's hammer to the Occam's razor

BMJ Case Rep. 2018 Sep 28:2018:bcr2018225827. doi: 10.1136/bcr-2018-225827.

Abstract

Leiomyosarcoma (LMS) of primary vascular origin is a rare entity with only potentially curative option being complete surgical resection; despite which the prognosis remains dismal. Tumour recurrence is very common, and the benefits of adjuvant therapy are undefined. A 39-year-old woman presented with 6 months' history of abdominal pain, abdominal distension and pedal oedema. On evaluation, she was diagnosed to have chronic Budd-Chiari syndrome (BCS) secondary to a tumour arising from the inferior vena cava (IVC) on evaluation. Her liver decompensation included jaundice, gastrointestinal bleed and ascites. Following a detailed multidisciplinary team discussion, she underwent complete excision of the tumour along with a segment of the IVC with living donor liver transplantation. She remains disease-free 24 months following surgery. This is the first reported case of liver transplantation for IVC LMS causing chronic BCS.

Keywords: liver disease; surgical oncology; transplantation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Budd-Chiari Syndrome / diagnosis
  • Budd-Chiari Syndrome / etiology
  • Female
  • Humans
  • Leiomyosarcoma / complications
  • Leiomyosarcoma / pathology
  • Leiomyosarcoma / surgery*
  • Liver Transplantation / methods*
  • Living Donors
  • Tomography, X-Ray Computed
  • Vascular Neoplasms / complications
  • Vascular Neoplasms / pathology
  • Vascular Neoplasms / surgery*
  • Vena Cava, Inferior* / diagnostic imaging
  • Vena Cava, Inferior* / pathology