Epithelioid type leiomyosarcoma is rarely encountered outside of the abdomen or uterus. We present a case of posterior mediastinal leiomyosarcoma in a 45-year-old male with back pain and bilateral lower extremity weakness. Magnetic Resonance Imaging of the thoracic spine revealed a heterogeneous posterior mediastinal soft tissue mass infiltrating the vertebral body and epidural space with resultant spinal cord compression and edema. Positron Emission Tomography showed no evidence of distant metastatic spread. Histopathological characterization revealed epithelial type leiomyosarcoma. Despite multiple subtotal resections, radiotherapy, and salvage chemotherapy with successful restoration of the patient's neurological function, the tumor burden remained significant. The patient was subsequently lost to follow up and the clinical outcome remains unknown. To our knowledge this is the first reported case of epithelioid type posterior mediastinal leiomyosarcoma presenting with spinal cord compression and edema.

Primary mediastinal leiomyosarcomas are extremely rare. We report a case of leiomyosarcoma around the thoracic and abdominal aorta, mimicking an aortic hematoma, and discuss the diagnostic value of ultrasound.

A 63-year-old female was hospitalized for abdominal pain. Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta. Aortic hematoma was strongly suspected, and stents were placed by interventional surgery. About 1 mo postoperatively, the patient was re-hospitalized because of progressive abdominal pain. Ultrasound showed that the mass had a heterogeneous echo. In contrast-enhanced ultrasound, the hyperechoic regions were filled with contrast medium after the aortic region was, indicating that the blood supply was abundant but had no direct connection with the aorta. There was no obvious contrast medium-filling in the hypoechoic area. These findings were similar to those of malignant tumors with liquefaction and necrosis. Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor. Leiomyosarcoma was confirmed by postoperative pathology.

Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma. Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.

• Mediastinal
• Leiomyosarcoma
• Aortic hematoma
• Contrast-enhanced ultrasonography
• Case report

• Anterior mediastinum
• Histopathology
• Immunohistochemical analysis
• Leiomyosarcoma
• Sarcoma

• leiomyosarcoma
• mediastinal tumor
• pulmonary metastasis

• Mediastinum
• Mesenchymal tumours
• Soft tissue tumours

• Diagnosis, Differential
• Humans
• Mediastinum/pathology
• Mesoderm/pathology
• Soft Tissue Neoplasms/diagnosis
• Soft Tissue Neoplasms/pathology
• Thymoma/diagnosis
• Thymoma/pathology
• Thymus Neoplasms/diagnosis
• Thymus Neoplasms/pathology

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Leiomyosarcomas are rare causes of superior vena cava syndrome.

Leiomyosarcomas are an infrequent cause of malignant superior vena cava syndrome (VCS).

A 51-year old male patient was admitted for a three-day history of dyspnoea, dysphagia and erythema of the head and neck. Computed tomography and magnetic resonance imaging showed a lesion arising on the anterior mediastinum, which was in close proximity with a thrombus in the superior vena cava. Surgical excision was performed, including open resection of the primary tumour and an atrio-innominate vein bypass with 8-mm polytetrafluoroethylene (PTFE). Histology confirmed a leiomyosarcoma and postoperative radiotherapy sessions were performed. Due to evidence of enlargement of the thrombus, a second intervention was undertaken. In this procedure, a remainder of the primary tumour was resected and the superior vena cava reconstructed with an autologous pericardium patch. The patient recovered satisfactorily and was discharged on the seventh postoperative day, with no evidence for relapse after 10 months of follow-up.

Leiomyosarcomas comprise less than 2% of the tumours of the mediastinum and are a rare cause of paraneoplastic VCS. Male patients in their sixties are most commonly affected. Relapses seem to be common, and thus a careful follow-up is often recommended.

In spite of the limited data on the management of thoracic leiomyosarcomas, surgery is currently considered the mainstay of treatment.

• Leiomyosarcoma
• Superior vena cava syndrome
• Vascular neoplasms