Introduction
LMS, a subset of soft tissue sarcomas, refers to malignant smooth muscle neoplasms accounting for about 5-10% of all sarcomas. Natural history depends on the anatomic location where they arise. About 50% arise in the retroperitoneum/abdomen, including the visceral, uterine, and retroperitoneal, with the uterus being the most common location. Given these tumors’ enormous size and frequent location, abdominal pain, nausea, vomiting, anorexia, weight loss, fatigue, and malaise are their most common symptoms. [1] Retroperitoneal sarcoma (RPS) is relatively uncommon, accounting only for 10-15% of all soft tissue sarcomas. [2] In a population-based series from the Surveillance, Epidemiology, and End Results (SEER) database, the average annual prevalence of RPS was approximately 2.7 cases per one million population. [3] The LMS of the retroperitoneum arise from the inferior vena cava, its tributaries, or any small vessel. When diagnosed, they often emerge as a mass, usually in an enormous size. Most knowledge in treating inferior vena cava (IVC) LMS comes from case reports and case series. Surgical resection offers the best chance of long-term survival and for the likelihood of cure. Remarkably, the five-year disease-free survival rate of patients undergoing resection was between 30and 60%; however, the survival in those who did not undergo surgery was often below one year. [4-8] We aimed to share our experience in encountering RPL with vascular and ureteral adhesion in the operation room about a patient scheduled for surgery as a case of leiomyoma.