Soft Tissue Sarcoma Intimately Related to External Iliac Vessels: Surgical Challenges in a High-Risk Patient
Autores
Mónica Ferreira, Catarina Baía, Augusto Moreira, Joaquim Abreu de Sousa
Resumo Introdução
Vascular soft-tissue sarcomas are rare and challenging due to the potential need for vascular reconstruction and high perioperative risk.
Resumo Métodos
A 77-year-old man was found to have an inguinal mass involving the external iliac vessels during imaging after an ischemic stroke. MRI and CT angiography showed a 6.4 × 4.9 × 3.5 cm solid lesion inseparable from the iliac vessels near the inguinal ligament, with venous compression and arterial displacement. Biopsy revealed a spindle-cell mesenchymal neoplasm with smooth-muscle differentiation of uncertain malignant potential. Given recent stroke, comorbidities, and the high risk of vascular reconstruction, the tumor board deferred the surgical decision. After one year, with functional recovery but a 2 cm increase in size, surgery was indicated as arterial preservation seemed feasible.
Resumo Resultados
Complete excision was achieved with careful dissection and preservation of both external iliac vessels; no macroscopic invasion was observed and the tumor capsule remained intact. The postoperative course was uneventful.
Resumo Discussão
This case highlights the need for careful risk?benefit assessment when managing soft-tissue tumors involving major vessels. Even when imaging suggests vascular compromise, vessel-preserving surgery may be feasible, especially without confirmed malignancy. Nevertheless, preparedness for possible vascular resection and reconstruction remains essential.