European Journal of Radiology Extra 61 (2007) 45–48 Primary epithelioid leiomyosarcoma of the endothoracic fascia Luca Morelli a,* , Teresa Pusiol a , Irene Piscioli b , Stefano Licci c , Franca Del Nonno c , Andrea Falzone d , Marinella Neri d a Department of Pathology, “S. Maria del Carmine” Hospital, Piazzale S. Maria 6, 38068 Rovereto (TN), Italy b Department of Radiology, “S. Chiara” Hospital, Trento, Italy c Department of Pathology, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy d Department of Radiology, “S. Maria del Carmine” Hospital, Rovereto, Italy Received 12 April 2006; received in revised form 21 September 2006; accepted 3 November 2006 Abstract The case we describe is, to our knowledge, the first primary epithelioid leiomyosarcoma of the endothoracic fascia reported in the literature. The endothoracic fascia is localized between the costal parietal pleura and the inner face of the thoracic wall and contains connective, adipose, smooth muscular tissues, lymphoid aggregates and vessels. Malignant tumors of the endothoracic fascia are difficult to identify because they quickly infiltrate the lung, the chest wall and the mediastinum. When discovered, these tumors are classified as primary soft tissue sarcomas of these sites. In the present case, early diagnosis of an asymptomatic lesion allowed us to establish its origin in the endothoracic fascia. The CT characteristics suggested a non-aggressive lesion, with clearly defined profiles and without signs of infiltration of the adjacent lung, fat and cartilages. Histological differential diagnosis and role of radiology in the management of the case are discussed. As radiological techniques spread and improve, we expect the diagnosis of endothoracic fascia primary tumors could become more frequent. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Endothoracic fascia; Leyomiosarcoma; Epithelioid leyomiosarcoma 1. Introduction In the text of Terminologia Anatomica [1] the fasciae of the trunk are named as parietal, extraserosal and vis- ceral. Fascia parietalis is defined as a “generic term of the fascia, which lies outside the parietal layer of a serosa (peri- cardium, peritoneum, pleura, tunica vaginalis) and lines the wall of the cavity bodies. The parietal fascia of the thorax is called endothoracic fascia. It covers the internal surface of the sternum, the internal intercostal, subcostal and transverse thoracic muscles, and the diaphragm. Dorsally, it merges with the thoracic portion of the prevertebral fascia. Superiorly, it is continuous with the scalene or Sibson’s fascia, which forms the suspensory ligament of the pleura. Inferiorly, the endotho- racic fascia is continuous with the transverse (endoabdom- inal) fascia, which lines the entire wall of abdomen” [2] * Corresponding author. Tel.: +39 0464 453490; fax: +39 0464 453029. E-mail address: luca.morelli@apss.tn.it (L. Morelli). (Fig. 1). So, endothoracic fascia is by definition equivalent to the parietal abdominal or endoabdominal fascia [3]. The structure of the endothoracic fascia is composed of connec- tive, adipose, smooth muscular tissues, lymphoid aggregates and vessels. During the dissection, the endothoracic fascia is found firmly attached to the costal pleura, and during oper- ation there is no surgical cleavage plane between them. The visceral pleura has an interconnection with the transverse tho- racic muscle, the inner thoracic vessels, ribs, intercostal and infracostal muscles, the initial tract of the intercostal nerves and vessels, the sympatethic trunk, the azygos vein and the hemiazygos vein. At these anatomical sites, the endothoracic fascia can give rise to benignant or malignant neoplasm orig- inating from its components. To our knowledge, a primary malignant or benignant neoplasm arising from the endotho- racic fascia has never been reported before in any scientific magazine, nor we have found an international tumor classifi- cation of benign, malignant primary or secondary tumors of the endothoracic fascia in any pathologic anatomy book. 1571-4675/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrex.2006.11.002