Primary Venous Tumors: Two Rare Cases from a Vascular Surgery Perspective

Abstract

Introduction Primary venous tumors are exceptionally rare vascular neoplasms arising from the venous wall and are often misdiagnosed as venous thrombosis or inflammatory venous disease. Fewer than a few hundred cases have been reported worldwide. Their deep anatomical location and overlapping imaging features contribute to delayed diagnosis and treatment. We present two venous tumors of differing biological behavior to highlight diagnostic pitfalls and surgical management challenges. Case Presentation Two female patients with venous tumors were surgically treated at a tertiary hospital. The first case involved a high-grade venous leiomyosarcoma of the femoral–iliac venous system, initially misdiagnosed as deep vein thrombosis. Following neoadjuvant chemoradiotherapy, radical tumor resection was performed without venous reconstruction but with iliofemoral arterial bypass using a PTFE graft; a postoperative seroma at the incision site was identified at one month follow-up. The second case described intravascular leiomyomatosis arising from the inferior vena cava with venous obstruction. Complete en bloc tumor resection with caval replacement using a PTFE graft was performed. The patient reported no early postoperative complaints; however, intermittent abdominal pain was noted at two-year follow-up and was considered possibly related to postoperative scar formation. Histopathological examination confirmed the diagnoses. Discussion These cases emphasize the diagnostic challenges of venous tumors, particularly their frequent misinterpretation as thrombotic disease. Progressive symptoms despite adequate conservative or anticoagulant therapy and atypical imaging findings should raise suspicion for venous neoplasia. Although multimodal imaging is essential, definitive diagnosis relies on histopathology. Surgical management is often complex due to vessel wall infiltration and proximity to major vascular structures. Conclusions Venous tumors should be considered in cases of atypical or treatment-resistant venous disease. Early recognition, multidisciplinary evaluation, and complete surgical resection when feasible remain crucial for optimal outcomes. Reporting rare cases contributes to improved awareness and may help refine future diagnostic and therapeutic strategies.