Malignant
tumors arising from venous walls in the lower extremity are uncommon. Histologically they are divided into two groups:
hemangioendotheliomas of intermediate
malignancy and
leiomyosarcomas. This report describes a retrospective series of seven primary venous
tumors observed in four men and three women with a mean age of 49.8 years (range: 18 to 64 years) who underwent surgical treatment between 1985 and 1995. The
tumor was located in the superficial femoral vein in four patients, common femoral vein in two patients, and greater saphenous vein in one patient. A palpable
tumor was present in five patients, localized
pain in two patients, and
metastasis in two patients. The histological diagnosis was
leiomyosarcoma in six patients and
hemangioendothelioma in one patient. Surgical treatment consisted of complete resection in six patients and partial excision in one patient. Venous reconstruction was performed in two patients and adjuvant
radiation therapy in four patients. There was no operative morbidity/mortality. Median survival was 31 months. Four patients with
leiomyosarcoma died from
metastasis. Two patients with
leiomyosarcoma and one with
hemangioendothelioma are alive at 9 years, 16 months, and 9 months, respectively. Local recurrence was never observed after complete resection. The prognosis of venous
leiomyosarcoma of the lower extremities is poor due to early occurrence of
metastasis. Doppler ultrasound and MRI are useful to establish early diagnosis at the nontumoral stage. Improvement in the prognosis of
leiomyosarcoma may justify perioperative
chemotherapy before and after radical surgical excision.