A 33-year-old woman with a history of hereditary bilateral retinoblastoma as an infant presented to a primary care clinic with 1 week of right lower extremity swelling. At age 8 months, she was treated with right enucleation and left eye radiotherapy (50.4 Gy). At age 4 years, she developed a recurrence of the retinoblastoma in the nasal cavity and was treated with 4 cycles of vincristine, doxorubicin, and cyclophosphamide followed by 1 cycle of cisplatin, etoposide, and intrathecal cytarabine.
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Primary care evaluation was prompted by her mother, as the patient had not noticed her lower extremity edema. She had no fevers, weight loss, shortness of breath, chest pain, abdominal pain, or history of deep vein thrombosis. Her physical examination was notable for firm, nonpitting edema to the hip. She did not have any associated tenderness, inguinal lymphadenopathy, or palpable abdominal masses. Her vital signs were within normal limits and she ambulated comfortably. Laboratory work results, including a complete blood cell count with a differential, comprehensive metabolic panel, and D-dimer levels, were within normal limits. Doppler ultrasonography of her right lower extremity showed no deep vein thrombosis. A computed tomography venogram demonstrated a 4.0 × 3.5 cm mass of likely vascular origin that was extending into the right common iliac vein (Figure).
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Corresponding Author: Jason Lambden, MSPH, MD, Department of Internal Medicine, McGaw Medical Center of Northwestern University, 251 E Huron St, Chicago, IL 60611 (email@example.com).
Published Online: September 2, 2021. doi:10.1001/jamaoncol.2021.3811
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information and Seth Pollack, MD, Northwestern Medicine, for his contributions, for which he was not compensated.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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