(P 20) LEIOMYOSARCOMA OF THE THORACIC AORTA - A RARE CASE REPORT

Objective: Leiomyosarcoma (LMS) is rare and malignant mesenchymal tumor that grows from the smooth muscle tissue. Due to the origin the tumor it can present on multiple location throughout the body. We present to you a rare case of an LMS growing out of the thoracic aorta.

Methods: A 52-year-old woman with no significant prior medical conditions complained of shortness of breath. CT of the thorax showed a large mass situated in the mediastinum (pic 1). Cytology revealed leiomyosarcoma with ki 67 up to 44% in hot spots.
Preoperative exam included EBUS, gastroscopy and CT of the thorax and abdomen. No sign of the origin of the tumor and no sign of metastasis. Multidisciplinary team conference (MDT) decided on surgery up front.

Results: Access was established via a left side thoracotomy. The lung, pulmonal vein and the esophagus were cleared (pic 2). Perioperatively the tumor was found to be growing from the thoracic aorta. ECMO was initiated via left pulmonal vein and right femoral artery via 17 French canula. Resection of the tumor and the aortic wall followed. A 26 mm Hemashield Platinum interposition graft was placed (pic 3). Blood loss estimated to 5100 ml. Patient was discharged after eight days and started on adjuvant treatment, Doxorubicin and Dacarbazine, 4 weeks postop.
The pathological report stated an LMS likely from a vasa vasorum of the aortic wall, 95 mm in size, mitotic rate of 13 per 10 HPF, Trojani grade II and R0 resection (pic 4).
Follow-up CT 3 months after surgery showed no signs of recurrence

Conclusion: This case represents the importance of MDT and a surgical multidisciplinary team required for advanced sarcoma treatment and our conclusion is that sarcoma should only be managed by designated centers.