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Background <p>Soft tissue sarcomas are uncommon mesenchymal malignancies that typically manifest as extremity masses. Their highly vascular nature can induce arteriovenous shunting, potentially leading to venous complications. Venous aneurysms, which represent isolated dilations of the venous system, are rare vascular phenomena that can occur throughout the body, with iliac vein involvement being particularly uncommon. While these aneurysms can be primary or secondary in nature, secondary cases predominate and require prompt medical attention due to risks of rupture and thromboembolic events. This case report describes an unusual presentation of thigh soft tissue sarcoma complicated by external iliac venous aneurysm formation, highlighting the importance of early recognition and management of vascular complications in sarcoma patients.</p> Case presentation <p>A middle-aged male in his fifties presented to the emergency department with continuous bleeding from a wound over a right inguinal swelling that had been ongoing for four hours. Initial ultrasound examination revealed a large heterogeneous soft tissue tumor in the subcutaneous plane of the right proximal thigh region with increased vascularity. This was associated with a large fusiform dilatation arising from the proximal portion of the right external iliac vein, showing a 'yin-yang sign' on color Doppler, suggestive of a right external iliac vein aneurysm. These findings were confirmed by contrast-enhanced arteriography, venography, and histopathology. The condition was diagnosed as soft tissue sarcoma and was treated accordingly.</p> Conclusions <p>This case highlights the importance of comprehensive vascular assessment in soft tissue sarcoma patients, as these rare tumors (1% of all malignancies) can cause secondary venous aneurysms through increased retrograde flow. While initial diagnosis relies on duplex ultrasound with color Doppler, additional imaging modalities such as CT venography, real-time venography, and MRI are essential for detailed evaluation. Management options include surgical resection with venorrhaphy, patch repair, venous bypass, or endovascular techniques like coil embolization. This case emphasizes the necessity of early detection and appropriate intervention to prevent potentially life-threatening complications.</p>

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Sarcomatous tumor with external iliac vein aneurysm: a rare entity

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月13日

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  • Tushar Kalekar,
  • Neeha Amit Jhala,
  • Reetika Kapoor,
  • Eshan Chetan Durgi,
  • Karishma Krishnani

摘要

Background

Soft tissue sarcomas are uncommon mesenchymal malignancies that typically manifest as extremity masses. Their highly vascular nature can induce arteriovenous shunting, potentially leading to venous complications. Venous aneurysms, which represent isolated dilations of the venous system, are rare vascular phenomena that can occur throughout the body, with iliac vein involvement being particularly uncommon. While these aneurysms can be primary or secondary in nature, secondary cases predominate and require prompt medical attention due to risks of rupture and thromboembolic events. This case report describes an unusual presentation of thigh soft tissue sarcoma complicated by external iliac venous aneurysm formation, highlighting the importance of early recognition and management of vascular complications in sarcoma patients.

Case presentation

A middle-aged male in his fifties presented to the emergency department with continuous bleeding from a wound over a right inguinal swelling that had been ongoing for four hours. Initial ultrasound examination revealed a large heterogeneous soft tissue tumor in the subcutaneous plane of the right proximal thigh region with increased vascularity. This was associated with a large fusiform dilatation arising from the proximal portion of the right external iliac vein, showing a 'yin-yang sign' on color Doppler, suggestive of a right external iliac vein aneurysm. These findings were confirmed by contrast-enhanced arteriography, venography, and histopathology. The condition was diagnosed as soft tissue sarcoma and was treated accordingly.

Conclusions

This case highlights the importance of comprehensive vascular assessment in soft tissue sarcoma patients, as these rare tumors (1% of all malignancies) can cause secondary venous aneurysms through increased retrograde flow. While initial diagnosis relies on duplex ultrasound with color Doppler, additional imaging modalities such as CT venography, real-time venography, and MRI are essential for detailed evaluation. Management options include surgical resection with venorrhaphy, patch repair, venous bypass, or endovascular techniques like coil embolization. This case emphasizes the necessity of early detection and appropriate intervention to prevent potentially life-threatening complications.