# An Extremely Rare Anomaly: Unveiling Renal Vein-Originated Leiomyosarcoma

## TL;DR

This case report describes a rare leiomyosarcoma originating in the left renal vein, highlighting the challenges in diagnosis and treatment of this aggressive cancer.

## Contribution

The paper presents a rare case of primary renal vein-originated leiomyosarcoma, emphasizing its diagnostic and therapeutic challenges.

## Key findings

- Leiomyosarcoma of the renal vein is extremely rare and difficult to diagnose due to nonspecific symptoms and imaging findings.
- Radical surgical resection is the primary treatment, but prognosis remains poor, especially for high-grade tumors.

## Abstract

Introduction: Angiogenic leiomyosarcoma (LMS), a soft tissue sarcoma, primarily occurs in the inferior vena cava (IVC) in over 50% of cases, with renal vein LMSs being exceedingly rare. We present a case of primary LMS of the left renal vein.

Case Report: A 73-year-old woman with a history of hypertension and prior left colon adenocarcinoma presented with intermittent left flank pain. Imaging revealed a large left latero–aortic mass. Exploratory laparotomy confirmed a multinodular tumor around the left renal hilum, necessitating en bloc resection with left nephrectomy. Pathological examination identified it as a grade 2 LMS. The patient recovered well postoperatively with no complications.

Discussion: LMSs, especially of vascular origin, are rare and aggressive malignancies. Despite their insidious presentation, they predominantly manifest in women, typically adults, and often on the left side. Diagnosis is challenging due to nonspecific symptoms and imaging findings. Surgical resection remains the cornerstone of treatment, with complete resection offering better outcomes. Prognosis is poor, particularly with larger tumors, partial resection, and high-grade lesions. Adjuvant therapy's efficacy is uncertain.

Conclusion: LMS of the renal vein is a rare entity with challenging diagnosis and management. Radical surgical resection remains the mainstay, but prognosis is guarded, especially in high-risk cases. Further research is needed to optimize treatment strategies for this rare malignancy.