case_images: PMC9424754_01
case_images: Preoperative pelvic ultrasound and abdominal CTA. (A) Preoperative pelvic ultrasound. (B) Preoperative abdominal CTA.
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case_images: Abundant blood flow signals were seen in the parenchyma of the mass ( Figure 1A ). The lesion grew in the right lower abdomen, invaded the main renal vein at the right renal hilum plane, and the inferior vena cava, then reached the hepatic segment of the vena cava ( Figure 1B ).
case_images: HE staining of pathological tissue and abdominal CT 3D imaging of preoperative pelvic mass puncture. (A) HE staining of the pathological tissue of the preoperative pelvic mass (x200). Scale bar, 100mum. (B) Preoperative abdominal CT 3D imaging.
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case_images: The Hematoxylin-Eosin (HE) staining of pelvic mass biopsy tissue showed abnormal cell proliferation, deep nuclear staining, and obvious nuclear atypia ( Figure 2A ). No tumor thrombus was found in the renal vein and lower inferior vena cava ( Figure 2B ).
case_images: Intraoperative gross specimen and postoperative pathological HE staining results. (A) Tumors in the pelvic cavity. (B) Tumor in the inferior vena cava. (C) HE staining results in postoperative pathological examination (x200). Scale bar, 100mum. (D-G) Postoperative pathological IHC staining (SMA, H-Caldlesmin, PR, Ki-67 positive).
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case_images: Postoperative lesions were found to be solid tumors with a size of 16x10.5x17.5 cm ( Figure 3A ). The size of the inferior vena cava tumor was approximately 8x3x2 cm ( Figure 3B ). Postoperative pathological HE staining showed abnormal cell proliferation, dark blue nuclei, disordered arrangement, the disappearance of swirling arrangement, and obvious nuclear atypia ( Figure 3C ). The specific IHC results are as follows: two important indicators of leiomyosarcoma, SMA and H-Caldlesmin protein, were positive, progesterone receptor (PR) derived from the uterus also showed focal positive, and the Ki-67 index was estimated to be 60% ( Figures 3D-G ).
case_images: Diagnostic workflow diagram. The clinical manifestations of abdominal and low back pain must be differentiated from various age-related urinary system diseases. The patient underwent clinical examination, gynecological Doppler ultrasound, abdominal CTA, pelvic mass puncture biopsy (HE, IHC), and abdominal CT 3D imaging. Preoperative abdominal CT 3D imaging made the clear scope of the lesion, the tumor was completely removed during the operation, and the final diagnosis was made by postoperative examination.
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case_images: The detailed diagnosis process is shown in  Figure 4 .
case_images: Abdominal CTA 3 months after surgery.
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case_images: CT examinations were performed every three months ( Figure 5 ), and the patient was in good condition, with no recurrence or metastasis three months after surgery.