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Soukane L, Bouzas Cardaci M, Marechal C, Van Houte B, Vazquez C. Multidisciplinary management of testicular cancer complicated by thrombosis of the inferior vena cava: a case report. Acta Chir Belg 2018; 118:250-253. [PMID: 28678675 DOI: 10.1080/00015458.2017.1346037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Testicular cancer is a rare disease, most commonly seen in young adults. It represents 1% of solid cancers in men. Inferior vena cava (IVC) thrombosis remains a rare complication of testicular cancer and is often associated with a high risk of pulmonary embolism (PE). CASE REPORT The authors report a case of a 26-year-old man presenting with advanced testicular cancer, left-sided retroperitoneal metastasis and parietal infiltration of the IVC complicated with thrombosis of the left iliac vein and the IVC, both responsible for PE. DISCUSSION A multidisciplinary management which included curative excision of the lesions, placement of a temporary IVC filter and adjuvant chemotherapy permitted an optimal approach. No complications occurred and the post-operative healing was uneventful. No recurrences were observed on the long-term follow-up. CONCLUSIONS IVC Thrombosis is a rare complication that should be taken into consideration when diagnosing testicular cancer. Prompt diagnosis is crucial to minimize the risk of PE which can be life-threatening.
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Unusual presentation of testicular cancer with tumor thrombus extending to the inferior vena cava. Case Rep Urol 2015; 2015:160560. [PMID: 26000192 PMCID: PMC4426900 DOI: 10.1155/2015/160560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
A 45-year-old man with a left testis tumor with a 25 mm para-aortic lymph node swelling, multiple bilateral pulmonary metastases, bilateral pulmonary embolism, and inferior vena cava (IVC) thrombus underwent a radical orchidectomy in our institution. The thrombus extended from the left gonadal vein to the left renal vein to the IVC. The fluorine-18 fluorodeoxyglucose (f-FDG) positron emission tomography (PET) computerized tomography (CT) demonstrated a hypermetabolic focus in the retroperitoneum and in the IVC thrombus. Before orchidectomy only lactate dehydrogenase (LDH) was high but all the serum tumor markers increased postoperatively. The tumor was staged pT1N2M1aS1, which was an intermediate prognosis, based on the International Germ Cell Cancer Collaborative Group consensus (IGCCCG). After 4 courses of bleomycin, etoposide, and cisplatin (BEP) chemotherapy the patient's tumor markers normalized and the thrombus disappeared. There was only one residual retroperitoneal lymph node M1. Retroperitoneal lymph node dissection was performed. The pathological examination revealed only necrotic tissues. The patient has been disease-free since surgery.
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Natsuaki M, Numaguchi K, Tada H, Nakashima Y, Okabe M, Yamamoto Y. Recurrence of pulmonary embolism in young man with retroperitoneal tumor despite insertion of temporary IVC filter. Circ J 2009; 73:1756-8. [PMID: 19145040 DOI: 10.1253/circj.cj-08-0448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pulmonary embolism (PE) is a fatal disease that is very rare in young people. A 21-year-old man developed PE because of a retroperitoneal tumor. The inferior vena cava (IVC) was obstructed by the tumor, and thrombus existed in the right common iliac vein. Thrombolysis and heparinization improved his symptoms prior to urgent tumor resection. A temporary IVC filter was inserted the day before the operation, but 8 h later fatal massive PE occurred. At autopsy, the retroperitoneal tumor was revealed as a metastatic choriocarcinoma. Prophylactic use of a temporary IVC filter might have paradoxically induced recurrence of massive PE in this case.
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Affiliation(s)
- Masahiro Natsuaki
- Department of Cardiology, Saiseikai Fukuoka Hospital, Chuo-ku, Fukuoka, Japan.
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Jo JC, Lee DH, Kang BW, Lee SS, Sym SJ, Kim MK, Ahn JH, Lee JL, Kim SW, Suh C, Kang YK, Lee JS. Both-sided Intra-atrial Intracardiac Metastases as the Initial Presentation of Testicular Seminoma. Jpn J Clin Oncol 2007; 37:463-8. [PMID: 17591609 DOI: 10.1093/jjco/hym045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report a case of a 41-year-old man admitted with respiratory distress and found to have masses in both atria of the heart and in the testicle. The patient received palliative radiotherapy to relieving obstruction of blood flow tract caused by the intracardiac masses, followed by radical orchiectomy. After the diagnosis of testicular seminoma, he was treated successfully with 4 cycles of systemic chemotherapy. This is a rare case that presented with metastatic testicular seminoma involving both atria of heart and causing symptomatic obstruction of blood flow tract.
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Affiliation(s)
- Jae-Cheol Jo
- Division of Oncology, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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5
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Masui S, Onishi T, Arima K, Sugimura Y. Successful management of inferior vena cava thrombus complicating advanced germ cell testicular tumor with temporary inferior vena cava filter. Int J Urol 2005; 12:513-5. [PMID: 15948757 DOI: 10.1111/j.1442-2042.2005.01073.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of right testicular tumor with inferior vena cava (IVC) thrombus. Due to the risk of pulmonary embolization, a temporary IVC filter had been inserted during chemotherapy. There were no complications with the temporary IVC filter during the implantation period. The patient was safely treated with systemic chemotherapy using a temporary IVC filter followed by retroperitoneal lymph node and vena cava dissection.
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Affiliation(s)
- Satoru Masui
- Department of Urology, Mie University School of Medicine, Tsu, Mie, Japan
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6
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Weinberg NM, Zwas DR, Owen AN, Zangrilli JG, Van Tassell P. Left ventricular intracardiac metastatic germ cell tumor presenting with hemorrhagic cerebrovascular event. J Am Soc Echocardiogr 2004; 17:1080-3. [PMID: 15452476 DOI: 10.1016/j.echo.2004.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an unusual case of a 26-year-old man admitted with respiratory distress and found to have testicular cancer metastatic to the lung and heart. Twelve days after admission, the patient experienced multiple hemorrhagic strokes. Echocardiography demonstrated testicular cancer metastatic to the septal surface of the left ventricle of the heart with presumed embolization to the cerebrovascular region. The patient received chemotherapy and radiation therapy to the areas of tumor mass with subsequent resolution of tumor burden. This is the first reported case of metastasis from embryonal carcinoma of the testis to the left ventricle of the heart.
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Affiliation(s)
- Nicole M Weinberg
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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7
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Fishman AD, Hoffman A, Volterra F, Frymus M, Gentilluci M. Intracaval and intracardiac metastatic nonseminomatous germ cell tumor: a rare cause of hemolytic anemia and thrombocytopenia. Cancer Invest 2002; 20:996-1001. [PMID: 12449733 DOI: 10.1081/cnv-120005916] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Intracaval and intracardiac nonseminomatous germ cell tumor metastases although rare have been previously reported in the literature. Most cases arise as a result of direct hematogenous spread via invasion of the internal spermatic vein, or from lymphatic venous shunting. We report a unique case of disseminated testicular germ cell tumor that presented with extensive intracaval and intracardiac metastatic teratoma and with valvular involvement. These findings were heralded by the presence of a new cardiac murmur, anemia, and severe thrombocytopenia. Resection of the intracardiac mass, prompted by rapid tumor progression despite treatment with systemic chemotherapy, demonstrated mature teratoma and resulted in prompt normalization of the patients hematologic profile.
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Affiliation(s)
- Ari D Fishman
- Department of Medical Oncology, Montefiore Medical Center, 111 E 210th Street, Hofheimer 1, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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8
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de Boer HD, Haerkens MHTM, van der Stappen W, van Ingen G, Wobbes T. Testicular carcinoma: postmortem diagnosis after a car accident. Lancet 2002; 359:1666. [PMID: 12020528 DOI: 10.1016/s0140-6736(02)08591-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- H D de Boer
- Department of Anaesthesiology, University Medical Centre, St Radboud, Netherlands.
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9
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Laroia ST, Schell DA, Koch R, Potti A. Unusual presentations of germ cell tumors. Case 3. Nonseminomatous extragonadal germ cell tumor presenting with pulmonary emboli. J Clin Oncol 2001; 19:915-6. [PMID: 11157046 DOI: 10.1200/jco.2001.19.3.915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S T Laroia
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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10
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Beck SD, Lalka SG. Long-term results after inferior vena caval resection during retroperitoneal lymphadenectomy for metastatic germ cell cancer. J Vasc Surg 1998; 28:808-14. [PMID: 9808847 DOI: 10.1016/s0741-5214(98)70055-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The long-term sequelae of inferior vena caval (IVC) resection during retroperitoneal lymph node dissection for metastatic nonseminomatous germ cell testis tumor (NSGCT) were assessed. METHODS Between December 1973 and September 1996, 2126 of our patients underwent RPLND for retroperitoneal nodal metastases from NSGCT; 955 had bulky disease (stages B2, B3, or C) after cytoreduction chemotherapy. Of this latter group, 65 patients (6.8%) required infrarenal IVC resection during tumor excision for cure. Our protocol does not include IVC reconstruction in such cases. Indications for IVC resection included tumor encasement or encroachment, postchemotherapy desmoplastic compression, or thrombus with tumor or clot in which cavotomy and thrombectomy cannot be performed. RESULTS Twenty-four of the 65 patients (postoperative follow-up period range, 11 months to 16 years; median, 89 months) were alive and able to be examined or interviewed by written and/or phone survey to assess the long-term morbidity of their IVC resection. Based on the 1994 American Venous Forum International Consensus Committee reporting standards, the clinical classifications of these 24 patients were C0A (4), C3S (4), C4A (2), C4S (13), and C6A (1). Long-term disability was mild or absent in 75% of these patients. CONCLUSION Only 1 (4.2%) of the patients surveyed had chronic venous sequelae that would fulfill the accepted criteria for subsequent elective IVC reconstruction. Despite recent reports of IVC reconstruction demonstrating relatively good patency rates and low morbidity, the addition of such a complex, time-consuming procedure to extensive retroperitoneal lymph node dissection for metastatic NSGCT involving IVC resection is generally not necessary.
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Affiliation(s)
- S D Beck
- Department of Urology, and the Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
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11
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Savarese DM, Rohrer MJ, Pezzella AT, Davidoff A, Fraire AE, Menon M. Successful management of intracardiac extension of tumor thrombus in a patient with advanced nonseminomatous germ cell testicular cancer. Urology 1995; 46:883-7. [PMID: 7502438 DOI: 10.1016/s0090-4295(99)80366-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A young patient with testicular germ cell tumor presenting with inferior vena cava thrombus extending into the right heart with free-floating thrombus in the right ventricle and a simultaneous epidural spinal cord compression is presented. Due to the perceived high risk of embolization and the urgent need to begin systemic chemotherapy, he was managed with tumor thrombectomy utilizing cardiopulmonary bypass and hypothermic circulatory arrest followed shortly thereafter by systemic chemotherapy. There were no perioperative complications, and he is alive and without recurrence 24 months following four cycles of systemic chemotherapy.
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Affiliation(s)
- D M Savarese
- Department of Medicine, University of Massachusetts Medical Center, Worcester 01655, USA
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12
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Adsan O, Müftüoglu YZ, Süzer O, Bedük Y. Thrombosis of the inferior vena cava by a testicular tumour. Int Urol Nephrol 1995; 27:179-82. [PMID: 7591575 DOI: 10.1007/bf02551316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report on an unusual case of testicular tumour presenting as thrombosis of the inferior vena cava. The inferior vena cava thrombosis due to tumour invasion is a rare presentation of testicular tumour. After four cycles of chemotherapy, the tumour which invaded and obstructed the vena cava was replaced by scar tissue.
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Affiliation(s)
- O Adsan
- Department of Urology, Avicenna (Ibn-i Sina) Hospital of Medicine, Ankara University, Turkey
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13
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Donohue JP, Thornhill JA, Foster RS, Bihrle R. Vascular considerations in postchemotherapy. Retroperitoneal lymph-node dissection: Part I--Vena cava. World J Urol 1994; 12:182-6. [PMID: 7820138 DOI: 10.1007/bf00185668] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A total of 42 patients underwent inferior vena cava resection (n = 40) or intraluminal tumor thrombectomy (n = 2) during retroperitoneal lymph-node dissection (RPLND) for bulky abdominal metastatic nonseminomatous germ-cell cancer (7% of all postchemotherapy RPLND cases). The three indications for caval resection included tumor clearance (38%), caval scar occlusion (14%), and caval tumor thrombus (48%). En bloc caval resection to achieve tumor clearance was justified by subsequent nodal pathology (cancer in 63% of specimens, teratoma in 31% specimens). Caval resection in the presence of scar occlusion was required de facto by virtue of its incorporation in the specimen. Caval resection or thrombectomy is indicated for intraluminal tumor thrombus because thrombus pathology (cancer, 35%; teratoma, 45%; fibrosis, 20%) reflected nodal pathology in 71% of cancer cases, 78% of teratoma cases, and 100% of fibrosis cases. The complications of caval resection were generally transitory. The 71% survival rate justifies this intensive surgical approach because these patients had exhausted all chemotherapeutic options.
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Affiliation(s)
- J P Donohue
- Indiana University Medical Center, Department of Urology, Indianapolis 46202-5250
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14
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Kwok CK, Horowitz MD, Livingstone AS, Block NL. Mature testicular teratoma with vena caval invasion presenting as pulmonary embolism. J Urol 1993; 149:129-31. [PMID: 8417194 DOI: 10.1016/s0022-5347(17)36021-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report a case of mature testicular teratoma with invasion and thrombosis of the inferior vena cava that presented as recurrent pulmonary embolism. Treatment included radical orchiectomy, chemotherapeutic cytoreduction and, finally, resection of a massive retroperitoneal tumor with en bloc resection of the inferior vena cava using cardiopulmonary bypass and deep hypothermic circulatory arrest. Management is discussed and the literature is reviewed.
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Affiliation(s)
- C K Kwok
- Department of Urology, University of Miami/Jackson Medical Center, Florida
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Abstract
We report a case of testicular teratocarcinoma involving the inferior vena cava with extension to the right atrium and metastases to the tricuspid valve. We believe this to be the first such reported case.
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Affiliation(s)
- T D Moon
- Department of Urology, Tulane University, New Orleans, Louisiana
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16
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Abstract
Inferior vena caval (IVC) obstruction and pulmonary embolism (PE) were observed in three patients with untreated germ cell tumors. A review of the literature revealed nine similar cases. The clinical presentation and specific management of IVC occlusion and PE may delay or interfere with definitive treatment of the tumor. The occurrence of this complication before starting cytotoxic chemotherapy has implications with regard to other types of vascular disease observed in patients with these tumors.
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Affiliation(s)
- M Stockler
- Department of Clinical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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17
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Donohue JP, Thornhill JA, Foster RS, Rowland RG, Bihrle R. Resection of the inferior vena cava or intraluminal vena caval tumor thrombectomy during retroperitoneal lymph node dissection for metastatic germ cell cancer: indications and results. J Urol 1991; 146:346-9. [PMID: 1649925 DOI: 10.1016/s0022-5347(17)37789-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A total of 42 patients underwent inferior vena caval resection (40) or intraluminal tumor thrombectomy (2) during retroperitoneal lymph node dissection for bulky abdominal metastatic nonseminomatous germ cell cancer (7% of all post-chemotherapy retroperitoneal lymph node dissection cases). The 3 indications for vena caval resection included tumor clearance (38%), vena caval scar occlusion (14%) and vena caval tumor thrombus (48%). En bloc vena caval resection to achieve tumor clearance was justified by subsequent nodal pathology (cancer in 63% of the specimens and teratoma in 31%). Vena caval resection in the presence of scar occlusion was de facto required by virtue of its incorporation in the specimen. Vena caval resection or thrombectomy is indicated for intraluminal tumor thrombus because thrombus pathology (cancer 35%, teratoma 45% and fibrosis 20%) reflected nodal pathology in 71% of the patients with cancer, 78% with teratoma and 100% with fibrosis. The complications of vena caval resection were generally transitory. The 71% survival rate justifies this intensive surgical approach because these patients had exhausted all chemotherapy options.
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Affiliation(s)
- J P Donohue
- Department of Urology, Indiana University Medical Center, Indianapolis
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Concepcion RS, Koch MO, McDougal WS, Stewart JR, Merrill WH. Management of primary nonrenal parenchymal malignancies with vena caval thrombus. J Urol 1991; 145:243-7. [PMID: 1988710 DOI: 10.1016/s0022-5347(17)38303-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report our experience with the management of 7 primary nonrenal parenchymal malignancies with vena caval tumor thrombus. Included are 3 cases of adrenal cortical carcinoma and 1 each of transitional cell carcinoma, embryonal cell testicular carcinoma, pheochromocytoma and primary small cell carcinoma of the lung with metastases to the kidney. Surgical treatment and followup are presented, as well as a review of the literature. An aggressive surgical approach is warranted because prolonged survivals free of disease are possible.
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Affiliation(s)
- R S Concepcion
- Department of Urology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Abstract
We report a case of a teratoma thrombus within the inferior vena cava subsequent to chemotherapy for embryonal carcinoma of the testis. A review of the literature indicates that intracaval metastases occur in approximately 1 per cent of the patients with bulky retroperitoneal disease. Seminoma and embryonal carcinoma have been identified previously within the inferior vena cava, and teratoma is now added to that list. The potential lethality of teratoma owing to local growth alone is underscored by its intracaval presence in this case. We recommend close inspection of the inferior vena cava at operation for bulky disease to exclude an intracaval thrombus, as well as complete excision of all residual masses following chemotherapy for testis cancer.
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Affiliation(s)
- A Morgentaler
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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