The first described case of bizarre leiomyoma of the portal vein

Abstract

Vascular leiomyomas with bizarre nuclei are rare. Differentiation of these tumors from malignant lesions is essential to avoid unnecessary dissection and organ loss in surgery. Herein, we present a 39-year Kosovo woman with a bizarre leiomyoma arising from the portal vein. The patient presented to the general surgery clinic with a one-year history of abdominal pain, vomiting and back ache. No abnormality was observed on physical examination. On computed tomography, a 42x35 mm, cystic-solid mass in the pancreatic neck, wrapping the superior mesenteric vein for 360-degrees and the superior mesenteric artery for 180-degrees, was found. In contrast to preoperative findings, a 5x4 cm mass located behind the portal vein and reaching portal vein-superior mesenteric vein junction posteriorly was seen perioperatively. There was no relationship between the mass and the superior mesenteric artery. The tumor was excised with the posterior wall of the junction of the portal vein and the superior mesenteric vein. The end-to-end vascular anastomosis was performed between the portal vein and the superior mesenteric vein. After finishing distal pancreatectomy, the operation was accomplished without any complication. The patient was discharged on 10th day of the operation without any problem. In conclusion, vascular bizarre leiomyomas are rare tumors. It is impossible to diagnose these correctly before surgery. Perioperative use of pathological examination as a frozen section can be helpful to avoid unnecessary surgical procedures. © 2019 Informatics Publishing Limited. All rights reserved.