case_images: PMC10832606_01
case_images: Duplex sonography shows a mass compressing the femoral vein from dorsally.
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case_images: These findings were confirmed by duplex sonography, showing a structure with a diameter of 3 cm compressing the femoral vein (Fig. 1).
case_images: T1-weighted MR-images of the right groin are presented pre- (A) and post-application of contrast medium (B). (A) A tumor with a diameter of 26 x 24 x 54 mm is seen dorsal to the common femoral vein and artery. In the left lower corner, a magnification of the area of interest is shown. CFV = common femoral vein; CFA = common femoral artery. (B) Addition of contrast displays the compression of the common femoral vein, but no flow impairment is seen. In the left lower corner, a magnification of the tumor is presented.
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case_images: In the T1-weighted images, the signal of the tumor was comparable to the muscular signal, and after application of contrast medium, a slight enhancement of the tumor was observed (Fig. 2).
case_images: The intraoperative findings are presented. (A) The asterisk indicates the common femoral vein, whereas the arrow indicates the tumor compressing the vein from dorsally. (B, C) Intraoperative preparation steps. (D) Excised tumor. The arrow indicates its vascular supply deriving from the caudal border from the lesion.
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case_images: Intraoperatively, we found an elastic tumor compressing the right common femoral vein without infiltration of the surrounding tissue (Fig. 3).
case_images: (A) The histopathological examination shows spindle cells (smooth muscle cells) with no mitotic figures or nuclear atypia. Moreover, no necrosis is seen. (B) Immunohistochemical staining reveals a low CD34 expression. (C, D) Further immunohistochemical staining shows positivity for SMA and desmin.
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case_images: The histological examinations (Fig. 4) showed a proliferation of spindle cells resembling smooth muscle cells.
case_images: The timeline from first appearance of symptoms to the final diagnosis is represented. Four months after appearance of the first symptoms, swelling of the right ankle and foot, the patient was admitted to the vascular outpatient clinic to exclude venous insufficiency. At this time, duplex sonography of the venous system was unremarkable. After excluding arthritis of the right ankle serologically and radiologically and because of a progression of the edema to the entire leg, a CT scan was performed to exclude pelvic vein thrombosis. A tumor compressing the right common femoral vein was discovered. Significant compression of the venous flow were confirmed by duplex sonography. After 8 months, an MRI and a fine needle biopsy were performed, which provided no further information about the entity of the tumor. After 9 months, the patient was admitted to the surgical department and a month later he was scheduled for tumor excision. The tumor was successfully excised in toto and did not show any signs of infiltration. Histological analysis required external validation due to the rare histological configuration. Two weeks after surgery, deep soft tissue leiomyoma was confirmed. In summary, it took almost one year from initial clinical presentation to the final diagnosis.
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case_images: The selection process of the reviewed articles is represented. Of the 74 articles found in PubMed inserting the search term "deep soft tissue leiomyoma", 39 were excluded according to the exclusion criteria (no clinical cases reported, articles about leiomyosarcoma, leiomyoma of the uterus or retroperitoneum only, or other tumors). Thirty-five articles were included (5 case series and 30 case reports).
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case_images: The selection process is visualized in Fig. 6.