On the Origin of Abdominal Venous Leiomyosarcomas: The Role of the Sex-Hormone Drainage Pathways

Overview

Journal World J Oncol

Specialty Oncology

Date 2024 Sep 27

PMID 39328327

Authors

Usman Tarique

David P Cyr

Carlo Morosi

Brendan C Dickson

Giorgio Greco

Carol J Swallow

Dario Callegaro

Rebecca A Gladdy

Korosh Khalili

Affiliations

Soon will be listed here.

Abstract

Background: We hypothesized that abdominal venous leiomyosarcoma (AV-LMS) disproportionately originates in veins of the sex-hormone drainage pathway (SHDP). Our purpose was to classify the anatomical origin of AV-LMS in a large cohort using imaging and explore prognostic implications.

Methods: A retrospective review of imaging of all patients presenting with abdominal non-uterine LMS at a single tertiary oncology center was performed. Inclusion criteria were a biopsy-proven LMS of non-uterine abdominal/pelvic origin with pretreatment enhanced computed tomography (CT)/magnetic resonance imaging (MRI). Patients with uterine LMS or prior radiation were excluded. LMS site of origin was assigned by one expert radiologist and indeterminate sites were reviewed with a second external expert radiologist. Locations of inferior vena cava (IVC) tumors were subclassified based on a modification of prior literature. SHDP was defined as originating from ovarian/testicular vein, distal left renal vein, adrenal vein or mid-IVC (IIA).

Results: One hundred fifty-five (155) patients were included (92/152 (61%) female) with distant metastases found at presentation in 23/155 (14.8%). Most common organs of origins were veins (84/152, 55.3%), gastrointestinal (24, 15.8%), genital (11, 7.2%) and paratesticular/spermatic cord (11, 7.2%). For venous LMS, the adrenal (both sexes), mid-IVC (IVC IIA, females) and ovarian veins had the highest relative predilection for abdominal non-uterine LMS. Eighty-four (84/152, 55.3%) of tumors were SHDP. On multivariable analysis, both size and SHDP were significant predictors of distant metastases at presentation (P = 0.01), while sex, age, organ system/site and grade were not.

Conclusions: For both sexes, tumors arising from SHDP constitute the majority of AV-LMS and may impart a significantly lower risk of metastatic disease at presentation. Among veins, the adrenal veins had the highest predilection for LMS.

Citing Articles

Primary leiomyosarcoma of the scalp: a case report and review of the literature.

Gao S, Liu P, Liu J, Yang W, Yang S Front Oncol. 2025; 15:1533114.

PMID: 40007995 PMC: 11850309. DOI: 10.3389/fonc.2025.1533114.

References

Monroe E, Carney B, Ingraham C, Johnson G, Valji K . An Interventionist's Guide to Endocrine Consultations. Radiographics. 2017; 37(4):1246-1267. DOI: 10.1148/rg.2017160102. View

Fogle R, Stanczyk F, Zhang X, Paulson R . Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab. 2007; 92(8):3040-3. DOI: 10.1210/jc.2007-0581. View

Carvalho J, Thomas D, Lucas D . Cluster analysis of immunohistochemical markers in leiomyosarcoma delineates specific anatomic and gender subgroups. Cancer. 2009; 115(18):4186-95. DOI: 10.1002/cncr.24486. View

Laskin W, Fanburg-Smith J, Burke A, Kraszewska E, Fetsch J, Miettinen M . Leiomyosarcoma of the inferior vena cava: clinicopathologic study of 40 cases. Am J Surg Pathol. 2010; 34(6):873-81. DOI: 10.1097/PAS.0b013e3181ddf569. View

Miotto D, De Toni R, Pitter G, Seccia T, Motta R, Vincenzi M . Impact of accessory hepatic veins on adrenal vein sampling for identification of surgically curable primary aldosteronism. Hypertension. 2009; 54(4):885-9. DOI: 10.1161/HYPERTENSIONAHA.109.134759. View

Ferrari A, Sultan I, Huang T, Rodriguez-Galindo C, Shehadeh A, Meazza C . Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatr Blood Cancer. 2011; 57(6):943-9. PMC: 4261144. DOI: 10.1002/pbc.23252. View

Sasano H, Murakami H, Shizawa S, Satomi S, Nagura H, Harada N . Aromatase and sex steroid receptors in human vena cava. Endocr J. 1999; 46(2):233-42. DOI: 10.1507/endocrj.46.233. View

Mikhail G . Hormone secretion by the human ovaries. Gynecol Invest. 1970; 1(1):5-20. DOI: 10.1159/000301902. View

Kieffer E, Alaoui M, Piette J, Cacoub P, Chiche L . Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg. 2006; 244(2):289-95. PMC: 1602179. DOI: 10.1097/01.sla.0000229964.71743.db. View

10.

George S, Serrano C, Hensley M, Ray-Coquard I . Soft Tissue and Uterine Leiomyosarcoma. J Clin Oncol. 2017; 36(2):144-150. PMC: 5759317. DOI: 10.1200/JCO.2017.75.9845. View

11.

Maccaroni E, Lunerti V, Agostinelli V, Giampieri R, Zepponi L, Pagliacci A . New Insights into Hormonal Therapies in Uterine Sarcomas. Cancers (Basel). 2022; 14(4). PMC: 8870116. DOI: 10.3390/cancers14040921. View

12.

Hines O, Nelson S, Quinones-Baldrich W, Eilber F . Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer. 1999; 85(5):1077-83. View

13.

Rossi G, Auchus R, Brown M, Lenders J, Naruse M, Plouin P . An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2013; 63(1):151-60. DOI: 10.1161/HYPERTENSIONAHA.113.02097. View

14.

Yokoyama Y, Goda T, Sato K, Suzuki M, Kanda T, Sato Y . Leiomyosarcoma arising from the ovarian vein as a gynecologic malignancy: Two case reports and a review of the literature. J Obstet Gynaecol Res. 2022; 48(8):2224-2230. DOI: 10.1111/jog.15242. View

15.

Akhan S, Yavuz E, Tecer A, Iyibozkurt C, Topuz S, Tuzlali S . The expression of Ki-67, p53, estrogen and progesterone receptors affecting survival in uterine leiomyosarcomas. A clinicopathologic study. Gynecol Oncol. 2005; 99(1):36-42. DOI: 10.1016/j.ygyno.2005.05.019. View

16.

Cesmebasi A, du Plessis M, Iannatuono M, Shah S, Tubbs R, Loukas M . A review of the anatomy and clinical significance of adrenal veins. Clin Anat. 2014; 27(8):1253-63. DOI: 10.1002/ca.22374. View

17.

Hollenbeck S, Grobmyer S, Kent K, Brennan M . Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg. 2003; 197(4):575-9. DOI: 10.1016/S1072-7515(03)00433-2. View

18.

Davidson B, Kjaereng M, Forsund M, Danielsen H, Kristensen G, Abeler V . Progesterone Receptor Expression Is an Independent Prognosticator in FIGO Stage I Uterine Leiomyosarcoma. Am J Clin Pathol. 2016; 145(4):449-58. DOI: 10.1093/ajcp/aqw030. View

19.

Burke A, Virmani R . Sarcomas of the great vessels. A clinicopathologic study. Cancer. 1993; 71(5):1761-73. DOI: 10.1002/1097-0142(19930301)71:5<1761::aid-cncr2820710510>3.0.co;2-7. View

20.

Sakellariou M, Dellaportas D, Peppa M, Schizas D, Pikoulis E, Nastos K . Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports. In Vivo. 2020; 34(5):2233-2248. PMC: 7652436. DOI: 10.21873/invivo.12034. View