2021 Volume 85 Issue 2 Pages 222-
A 71-year-old-Japanese woman was admitted to hospital because of fever. She had undergone heavy iron radiotherapy to a sacral osteosarcoma 8 months ago, and 1 month after the therapy, she had acute pulmonary thromboembolism (PTE) and bilateral deep vein thrombosis (DVT) with compression of the right internal iliac vein by the sacral tumor. Warfarin therapy was started. However, she underwent percutaneous placement of an inferior vena cava (IVC) filter 2 months ago because of recurrent PTE despite appropriate warfarin treatment. On admission, she was diagnosed with acute pyelonephritis and her condition was improved by antibiotics. However, she had severe bilateral leg edema, and enhanced computed tomography (CT) was performed, which revealed thrombus of the left pulmonary artery (Figure A) and thrombus under the IVC filter (Figure B); the right common iliac vein did not have thrombus among the veins of the lower extremities. Intravenous urokinase (24,000 units/day) was added to the warfarin therapy. At 1 week after starting the treatment, CT showed no change in the thrombus under the IVC filter and increased size of the PTE. Aspiration thrombectomy was performed, and soft, white and red-colored materials that were different from typical thrombus were aspirated (Figure C). Histologically, round and spindle cells with bizarre nuclei similar to the primary myxofibrosarcoma of the sacrum were seen (Figure D). She was eventually diagnosed as having a thrombus of the sacral osteosarcoma.
Computed tomography shows a thrombus in the left pulmonary artery (A, arrow) and a thrombus under the IVC filter (B, arrow). White and red-colored aspirated material (C). Histology showing round and spindle cells with bizarre nuclei (D; H&E, ×100). IVC, inferior vena cava.
Thrombus arising from osteosarcoma is rare, so histological examination in this case was useful for the diagnosis.
K.M. is a member of Circulation Journal’s Editorial Team.
The authors state that they have no conflicts of interest.
