ABSTRACT
STUDY DESIGN: Case report of an anterior approach to the spine in the setting of variant vascular anatomy. OBJECTIVE: To highlight the importance of evaluating vascular anatomy before anterior lumbar spine surgery. SUMMARY OF BACKGROUND DATA: A 62-year-old woman with idiopathic scoliosis had thoracolumbar fusion in adolescence and subsequently developed symptomatic sub-adjacent segment breakdown. Vascular complications may be encountered during anterior approaches to the spine. Variation in vascular anatomy may compound the difficulty of an already meticulous dissection. RESULTS: A patient with idiopathic scoliosis who had thoracolumbar fusion in adolescence and subsequently developed symptomatic sub-adjacent segment breakdown. She underwent a 2-stage posterior/anterior procedure. During the anterior retroperitoneal approach, an anomalous left inferior vena cava was encountered that required tedious dissection for safe and adequate exposure of the lumbar spine. CONCLUSIONS: When planning anterior lumbar spine surgery, careful review of the vascular anatomy on imaging should be performed. This will help prepare the surgeon for more complex or anomalous anterior anatomy. If atypical vascular anatomy is identified, consideration of a pathologic cause should be investigated.
ABSTRACT
We present a case of an inflammatory leiomyosarcoma, a variant of smooth muscle cell tumor that could be mistaken for inflammatory malignant fibrous histiocytoma. The inflammatory cell infiltrates obscured the basic architecture of the tumor, and immunohistochemistry was required to arrive at the proper diagnosis. Since inflammatory leiomyosarcomas are rare and possibly misdiagnosed neoplasms, there are not enough data to indicate whether they deserve to be separated from other malignant smooth muscle cell neoplasms. By reporting this case we hope that more pathologists will become aware of this tumor type and that more cases will be collected for future clinicopathologic studies.
