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Ann Thorac Surg 1998;66:1405
© 1998 The Society of Thoracic Surgeons

Case Reports

Resection of a leiomyosarcoma of the azygos vein

Uday Dasika, MDa, Nazli Shariati, MDa, John M. Brown, III, MDa

a Morristown Memorial Hospital, Morristown, New Jersey, USA

Accepted for publication April 21, 1998.

Address reprint requests to Dr Brown, Morristown Memorial Hospital, 100 Madison Ave, Morristown, NJ 07962-1956
e-mail: (jbrown{at} heartsurgeons.com)


   Abstract
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 Abstract
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We report the resection of a leiomyosarcoma of the azygos vein in an elderly woman. The rare nature of the tumor and the unusual site of origin are discussed.


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The patient is a 74-year-old woman who was referred for evaluation of a solitary mediastinal mass visualized on routine preoperative chest roentgenography (Fig 1 ). Computed tomography of the chest revealed a well-circumscribed mass in the posterior mediastinum approximately 4 cm in diameter (Fig 2 ). Preoperative bronchoscopy was nondiagnostic, and the patient was referred for surgical removal of the lesion.



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  		Fig 1. Posteroanterior chest radiograph demonstrating the mediastinal mass.

 


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  		Fig 2. Computed tomographic scan of chest demonstrating the posterior mediastinal mass.

 
The patient underwent right posterolateral thoracotomy, which revealed a 5.5 by 5 by 4.2 cm mass densely adherent to the azygos vein and enveloping it. The mass did not involve any of the other surrounding structures. The mass was removed with the azygos vein after ligation of the azygos vein proximally and distally. Frozen section suggested leiomyosarcoma. There was no regional lymph adenopathy. Histopathologic analysis confirmed high-grade leiomyosarcoma arising from the azygos vein. The patient tolerated the procedure well and was discharged home on the sixth postoperative day.


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Vascular leiomyosarcomas account for 2% of all leiomyosarcomas. The tumor arises as a proliferation of the smooth muscle cells within the media. Vascular leiomyosarcoma is noted to have a fivefold predilection for veins over arteries. The most common site is noted to be the inferior vena cava [1]. A previous report by Levett and associates [2] noted vascular leiomyosarcoma arising from both the superior vena cava and the azygos vein, requiring resection and spiral vein graft replacement of the superior vena cava. Our intraoperative findings clearly demonstrated the mass’ origin from the azygos vein. The mass was excised with ligation of the azygos vein proximally and distally; no reconstruction was required. Subsequent histopathologic analysis confirmed origin of the mass from the azygos vein.


   References
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 Abstract
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 Comment
 References
 

  1. Kevorkian J., Cento D.P. Leiomyosarcoma of large arteries and veins. Surgery 1973;73:390-400.[Medline]
  2. Levett J.M., Meffet W.G., Strong W.W., et al. Leiomyosarcoma of the superior vena cava and azygos vein. Ann Thorac Surg 1995;60:1415-1417.[Abstract/Free Full Text]



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This Article
Right arrow Abstract Freely available
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Right arrow Alert me when this article is cited
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Right arrow Email this article to a friend
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Right arrow Similar articles in PubMed
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Right arrow Add to Personal Folders
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Right arrow Author home page(s):
Uday Dasika
John M. Brown, III
Right arrow Permission Requests
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Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dasika, U.
Right arrow Articles by Brown, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dasika, U.
Right arrow Articles by Brown, J. M., III

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