Intramural sarcoma of the carotid artery with adventitial inflammation and fibrosis resembling 'inflammatory aneurysm'

A rare case Is descrlbed of an Intramural sarcoma of the rlght common carotld artery coexistlng wlth adventitial inflammation and flbrosls, resembllng 'inflammatory aneurysm', which was resected from a 33-yearold Japanese woman who had presented with a pulsatile mass on the rlght side of the anterior neck. Grossly, the wall of the carotld artery showed an intimal tear with dlssectlon of the medla filled with thrombus. A graylsh area, abutting directly onto the dlssected space and Involving the media and inner adventltia, was composed of a-smooth muscle actin-positive and desmln-negative polygonal and splndle cells with large bluntended nuclei and coarse granular chromatin arranged Into a well-organized Interlacing bundle pattern. This portlon was thus considered to represent lelomyosarcoma. White to yellow-tan fibrotic tissue present in the adventitial area consisted of extensive lamellar fibrosis wlth scattered focl of lymphoplasmacytlc aggregates and obliterated arteries, and lacked atypical spindle and polygonal cells. These changes accorded with the histopathologlcal findlngs hitherto described in cases of 'inflammatory aneurysm', which is known to almost exclusively involve the abdominal aorta. We conslder this case unique In that the leiomyosarcoma involved an artery other than the aorta, wlth an 'inflammatory aneurysm'-like reaction in the same she. The posslble relatlonship between these two condltions Is dlscussed.