Case Report Open Access J Surgery ISSN: 1584-9341 JOS, an open access journal Volume 10 • Issue 3 • 12 Keywords: Smooth muscle tumors; Leiomyosarcoma; Renal vein Introduction Leiomyosarcoma is the third commonest primary retroperitoneal malignancy following liposarcoma and malignant fbrous histiocytoma. However, most of these are intramuscular in origin. Only about 5% of leiomyosarcomas arise directly from large blood vessels [1]. Te majority of vascular wall related leiomyosarcomas originate from the inferior vena cava. Primary leiomyosarcomas originating from the renal veins are extremely rare; approximately 30 cases have been documented [2] as almost all being case reports. Most tumors are diagnosed at advanced stages because the disease has a relatively silence course initially and usually presents with nonspecifc clinical signs. Case A 40-year-old woman presented to our clinic with the complain of back pain. She had no signifcant medical history. Routine biochemical work-up was normal. Upper abdominal ultrasound revealed a lef retroperitoneal mass. Te mass was described as a tumor that was not related to renal parenchyma or excretory route but in close contact with the renal vein. Further evaluation with contrast enhanced axial CT scan showed an infltrative, probably malignant lef retroperitoneal mass 7 cm in size neighboring the lef renal hilum. Afer informed consent was obtained, the patient underwent exploratory laparotomy. During the operation, a multinodular solid tumor with a size of 7×6.5×3 cm, originating from the lef renal vein was observed (Figure 1). Te mass which is strongly adhere was not resected totally without lef renal vein. So we decided to do a complete circumferential resection, and reconstruction of the lef renal vein. Te renal vein was freed from the surrounding tissue along its course preserving lef gonadal vein. Afer en-bloc, kidney preserving resection of the mass including invaded part of the vessel was completed (Figure 2), an end to end anastomosis of the vein was performed using 6/0 polypropylene (Figure 3). Histopathological examination showed that the tumor was a moderately diferentiated leiomyosarcoma originating from the wall of the renal vein. It was also confrmed that all resection margins were negative. Te early postoperative period was uneventful and the patient was discharged home on fourth day. Two years afer receiving adjuvant chemoradiotherapy she is still doing well without any symptom or sign of recurrence. Discussion Primary vascular leiomyosarcomas are quite rare; less than 300 cases have been reported in the literature mostly in the form of single case report. Leiomyosarcoma which is orginating from vascular system can be fatal problem. More than half of them stem from IVC with a female predominance of 3:1 [3]. Patients with vascular leiomyosarcoma are usually in their sixth or seventh decade of life, but our case was in her forth decade [4]. Te tumor is situated on the lef-side 60 percent of the time. As was in the present case, these type of tumors are generally diagnosed at an advanced stage due to nonspecifc clinical signs. As a natural result of extremely rare occurrence of the disease, *Corresponding author: Murat Urkan, General Surgery, Gülhane Mılıtary Medıcal Academy, Ankara 06100, Turkey, Tel: +905327817557; Fax: +905327817557; E-mail: muraturkan@gmail.com Received July 19, 2014; Accepted July 22,, 2014; Published July 25, 2014 Citation: Urkan M, Yağci G, Özerhan IH, Öztürk E, Ünlü A. Kidney Preserving Resection of Leiomyosarcoma with Reconstruction of Left Renal Vein: Case Report. Journal of Surgery [Jurnalul de chirurgie] 2014; 10(3): 251-252 DOI: 10.7438/1584-9341-10-3-12 Copyright: © 2014 Urkan M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Leiomyosarcoma is a common retroperitoneal sarcomas mostly originating from muscles. Only about 5% of leiomyosarcomas arise directly from large blood vessels and more than 50% of cases originate from inferior vena cava. Primary leiomyosarcomas of renal veins are extremely rare (30 cases). Mostly diagnosed at advanced stages because of nonspecifc clinical signs. Case: A 40-year-old woman was evaluated of a left retroperitoneal mass with severe back pain. CT scan revealed a left retroperitoneal mass 7 cm. in size adjacent to left renal hilum. During the operation; a multilobular, solid tumor in 7 x 6.5 x 3 cm size, surrounding the left renal vein was observed. Further dissection revealed that the tumor was originated from left renal vein wall. Total devascularization and partial left renal vein resection with tumor and end to end anastomosis was performed. Vascular outfow was confrmed with intraoperative and postoperative doppler examination. Pathology was reported as moderately differentiated leiomyosarcoma, originated from renal vein wall with tumor free resection margins and the patient was discharged with adjuvant chemoradiotherapy. Conclusion: Although the radical nephrectomy is the gold standard approach for malign tumors of the kidney, kidney preserving tumor free resection with vascular reconstruction is a feasible alternative followed by adjuvant chemoradiotherapy and close follow up. Kidney preserving tumor free resection with vascular reconstruction and followed by adjuvant chemoradiotherapy is a feasible alternative instead of radical nephrectomy. Kidney Preserving Resection of Leiomyosarcoma with Reconstruction of Left Renal Vein: Case Report Murat Urkan 1 *, Gökhan Yağci 1 , İsmail Hakk Özerhan 1 , Erkan Öztürk 1 , Aytekin Ünlü 1 , Mehmet Gamsizkan 2 and Yusuf Peker 1 1 Department of General Surgery,Gulhane Mılıtary Medıcal Academy, Ankara 06100, Turkey 2 Department of Pathology, Gulhane Mılıtary Medıcal Academy, Ankara 06100, Turkey Journal of Surgery [Jurnalul de Chirurgie] J o u r n a l o f S u r g e r y [ J u r n a l u l d e C h i r u r g i e ] ISSN: 1584-9341