If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Reprint requests: A. Celdrán, MD, Department of Surgery, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Av Reyes Católicos, n° 2, 28040 Madrid, Spain.
Affiliations
From the Departments of General Surgery, Vascular Surgery, Radiology, Gastroenterology, and Pathology, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Madrid, Spain
From the Departments of General Surgery, Vascular Surgery, Radiology, Gastroenterology, and Pathology, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Madrid, Spain
From the Departments of General Surgery, Vascular Surgery, Radiology, Gastroenterology, and Pathology, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Madrid, Spain
From the Departments of General Surgery, Vascular Surgery, Radiology, Gastroenterology, and Pathology, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Madrid, Spain
From the Departments of General Surgery, Vascular Surgery, Radiology, Gastroenterology, and Pathology, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Madrid, Spain
From the Departments of General Surgery, Vascular Surgery, Radiology, Gastroenterology, and Pathology, Clı́nica “Nuestra Señora de la Concepción,” Fundación Jiménez Dı́az, Madrid, Spain
A 66-year-old man was admitted to the hospital with epigastric pain radiating bilaterally to the back. The patient's
history was significant for smoking, prior ethanol abuse, hypertension, and colonic
polypectomy for benign tubular adenoma. Physical examination did not show any pathologic
signs except epigastric pain to superficial and deep abdominal palpation. Peripheral
blood count and biochemical test results were normal. A sonogram showed a mass over
the mesenteric vein. Abdominal computed tomography confirmed the sonographic findings
of a 4-cm lobulated mass arising from the mesenteric vein with necrotic areas. The
duodenal wall and the superior mesenteric artery were not affected (Fig 1). Laparotomy confirmed a lobulated tumor arising from the anterior wall of the superior
mesenteric vein caudal to the portal vein, superior mesenteric vein confluence, and
proximal to the initial secondary mesenteric venous branch. The tumor also grew in
the right colonic mesentery along the medial colic vessels. The segment of superior
mesenteric and portal veins containing the tumor was isolated by sectioning the first
secondary mesenteric veins and the medial colic vessels in the mesocolon (Fig 2). The tumor was resected, and mesenteric venous flow was restored through an autogenous
saphenous vein interposition graft. A right hemicolectomy was performed for colonic
ischemia recognized after ligation of the middle colic vein. The postoperative course
was uneventful. On cut section, the tumor showed homogeneous firm white tissue, and
microscopically, it was made up of interlacing bundles of neoplastic smooth muscle
fibers infiltrating the wall of the mesenteric vein without involving surgical margins.
The nuclei were elongated, with hypercromasia and variation in size and shape, and
18 mitoses were counted in 10 high-power fields. Superior mesenteric vein graft patency
was confirmed with abdominal computed tomography 6 months after surgery.
Fig 1Computed tomographic scan image with contrast enhancement shows well-defined nodular
tumor (between arrows) involving superior mesenteric vein and narrowing its lumen.
