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Síndrome de Cushing secundario a carcinoma de la glándula suprarrenal izquierda con metástasis hepáticas y trombosis tumoral masiva de la vena cava. BIOMÉDICA 2012. [DOI: 10.7705/biomedica.v32i4.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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2
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Mann GN, Mann LV, Levine EA, Shen P. Primary leiomyosarcoma of the inferior vena cava: A 2-institution analysis of outcomes. Surgery 2012; 151:261-7. [DOI: 10.1016/j.surg.2010.10.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 10/18/2010] [Indexed: 11/24/2022]
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3
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Rötker J, Schmid Ç, Oberpennig F, Knichwitz G, Tjan T, Hertle L, Scheld H. Surgery of the inferior vena cava for tumor-related obstruction. Int J Angiol 2011. [DOI: 10.1007/bf01618394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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4
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Tori M, Akamatsu H, Ueshima S, Tsujimoto M, Nakahara M. Recurrent Ascending Colon Cancer Manifesting as Inferior Vena cava Thrombus. Case Rep Gastroenterol 2008; 2:181-6. [PMID: 21327176 PMCID: PMC3037984 DOI: 10.1159/000132359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report an extremely rare case of recurrent ascending colon cancer manifesting as inferior vena cava (IVC) thrombus. A 77-year-old woman previously diagnosed with ascending colon cancer underwent right hemicolectomy with lymph node dissection. Though the tumor invaded the retroperitoneum and involved the right ovarian artery and vein, curative operation was performed. The patient took 5-FU p.o. Two and a half years later, tumor thrombus in the IVC extending into the right atrium was incidentally found and diagnosed as recurrence of colon cancer by biopsy. RF-induced hyperthermia using 5-FU and CDDP i.v. was immediately performed, but she died after 6 months because of multiple liver and pulmonary metastases. In treating colon cancers invading the retroperitoneum, it should be recalled that some cases recur as tumor thrombus in the IVC and that close follow-up is therefore necessary.
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Affiliation(s)
- Masayuki Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Chiche L, Dousset B, Kieffer E, Chapuis Y. Adrenocortical carcinoma extending into the inferior vena cava: Presentation of a 15-patient series and review of the literature. Surgery 2006; 139:15-27. [PMID: 16364713 DOI: 10.1016/j.surg.2005.05.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 05/15/2005] [Accepted: 05/20/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Involvement of the inferior vena cava (IVC) is a controversial risk factor for surgical treatment of adrenocortical carcinoma (ACC). This study aims to assess the outcome of an aggressive surgical policy for ACC extending into the IVC and discuss treatment strategies based on a review of the literature. METHODS Over a 25-year period, 15 patients were treated for ACC extending into the IVC. The upper limit of the extension was the infrahepatic IVC in 2 patients, retrohepatic IVC in 6, and suprahepatic IVC in 7, including 4 with extension into the right atrium. Seven patients presented with concurrent metastases. The operative technique was thrombectomy (n = 13), partial resection with direct closure (n = 1), and total resection with replacement of the IVC (n = 1). Venous control was achieved by caval clamping alone (n = 4), hepatic vascular exclusion (n = 5), and the use of normothermic cardiopulmonary bypass or hypothermic circulatory arrest (n = 6). RESULTS Two patients died postoperatively. Ten patients died of metastatic complications at 4 to 31 months. Median survival time was 8 months. Three patients were still alive after 24, 25, and 45 months of follow-up, one of whom was reoperated at 17 months for a local recurrence. No evidence of recurrent intravenous involvement was found during follow-up in any patient in whom complete resection was achieved. CONCLUSIONS Our findings suggest that surgical treatment can be effective for management of ACC with extension into the IVC. Long-term prognosis is poor owing to delay in diagnosis, frequent associated metastatic disease and lack of effective adjuvant treatment.
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Affiliation(s)
- Laurent Chiche
- Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
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6
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Dew J, Hansen K, Hammon J, McCoy T, Levine EA, Shen P. Leiomyosarcoma of the Inferior Vena Cava: Surgical Management and Clinical Results. Am Surg 2005; 71:497-501. [PMID: 16044929 DOI: 10.1177/000313480507100609] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Leiomyosarcoma of the inferior vena cava (IVC) is a rare lesion with less than 300 cases reported. Optimal management and long-term outcomes are not well described. From August 1984 to June 2004, eight patients with leiomyosarcoma of the IVC were treated at our institution. Clinical and pathologic data, surgical management, and outcomes were assessed. Eight cases were identified (4 males) with a median age of 52 (range 29–66). Presenting symptoms included abdominal pain (n = 5, 63%), lower extremity edema (n = 2, 25%), and palpable mass (n = 2, 25%). Tumor location was between the renal and iliac veins (low) (n = 4, 50%), between the hepatic and renal veins (middle) (n = 3, 38%), and above the hepatic veins with right atrial extension (high) (n = 1, 12%). Two patients with preoperative IVC occlusion were managed with tumor excision and IVC ligation. Three patients had primary repair of the IVC after tumor excision. A polytetrafluorothylene (PTFE) tube graft was used for IVC reconstruction in three cases. There was no postoperative mortality. Postoperative morbidity included deep venous thrombosis (DVT) (n = 1), lower extremity edema (mild n = 1; moderate n = 1), GI bleed (n = 1), and chronic renal insufficiency (n = 1). One patient is currently receiving adjuvant chemotherapy. Four patients received chemotherapy after recurrence, and one received palliative radiation therapy as well. Median survival to this point was 60 months with a median follow-up of 39 months. The 5-year overall survival and disease-free survival was 31 per cent for both (CI 0.1–1.0). The type of IVC reconstruction had no effect on survival ( P = 0.22). Recurrence was discovered in four patients (50%) at a median time of 14 months. Resection of leiomyosarcoma of the IVC should be attempted whenever feasible. The management of the IVC can be managed with primary repair, ligation, or prosthetic graft. Long-term survival is possible if complete resection can be achieved.
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Affiliation(s)
- Jason Dew
- Wake Forest University School of Medicine, Department of Surgery, Surgical Oncology, Vascular Surgery Service, Winston-Salem, North Carolina 27157, USA
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7
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Rosen B, Rozenman Y, Harpaz D. Extension of adrenocortical carcinoma into the right atrium--echocardiographic diagnosis: a case report. Cardiovasc Ultrasound 2003; 1:5. [PMID: 12777180 PMCID: PMC156660 DOI: 10.1186/1476-7120-1-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Accepted: 05/16/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma is a rare, highly malignant tumor. Cardiac involvement of the tumor is very rare. Echocardiography facilitates the evaluation of the cardiac involvement of the tumor. CASE PRESENTATION We describe a patient with an adrenal tumor. Transthoracic echo showed its extension into the right atrium. Accordingly, a combined abdominal and cardiac operation was performed, monitored by transesophageal echocardiography. CONCLUSION This case highlights the importance of echocardiography in revealing the cardiac involvement by this tumor and in planning the operative procedure.
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Affiliation(s)
- Boaz Rosen
- The Heart Institute, E Wolfson Medical Center, Holon, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoseph Rozenman
- The Heart Institute, E Wolfson Medical Center, Holon, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Harpaz
- The Heart Institute, E Wolfson Medical Center, Holon, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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CIANCIO GAETANO, VAIDYA ANIL, SAVOIE MARK, SOLOWAY MARK. Management of Renal Cell Carcinoma With Level III Thrombus in the Inferior Vena Cava. J Urol 2002. [DOI: 10.1097/00005392-200210010-00016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ciancio G, Vaidya A, Savoie M, Soloway M. Management of renal cell carcinoma with level III thrombus in the inferior vena cava. J Urol 2002; 168:1374-7. [PMID: 12352396 DOI: 10.1016/s0022-5347(05)64452-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Level III thrombus in the inferior vena cava poses a challenge to the surgeon due to its relative inaccessibility. We introduce a new system to redefine level III thrombus in anatomical relation to the hepatic veins and describe a technique of safe resection of these tumors through a transabdominal approach without recourse to cardiopulmonary bypass. MATERIALS AND METHODS From August 1997 to July 2001, 23 patients underwent resection of renal cell carcinoma with a level III thrombus. Intraoperative as well as postoperative variables such as operative time, estimated blood loss, number of transfusions, cardiopulmonary bypass, postoperative complications, pathological findings and survival were recorded. RESULTS A total of 15 male and 8 female patients with a mean age of 62 years (range 25 to 83) underwent resection of a level III thrombus emanating from renal cell carcinoma. Patients were divided into groups IIIa-9 with an infrahepatic thrombus, IIIb-6 with a hepatic thrombus, IIIc-5 with a suprahepatic, infradiaphragmatic thrombus and IIId-3 with a suprahepatic, supradiaphragmatic, infra-atrial thrombus. Mean operative time was 5 hours 42 minutes (range 4 to 7.5 hours). The number of transfusions was 0 to 4. Estimated blood loss was 100 to 5,000 cc (mean 500). Neither cardiopulmonary bypass nor veno-venous bypass was required. Median followup was 25 months. Two patients (9%) died, including 1 in the immediate postoperative period and the other from metastasis 15 months after surgery. At the last followup 3 patients (13%) had metastasis and 18 (78%) were disease-free for overall and disease-free survival rates of 91% and 78%, respectively. CONCLUSIONS An aggressive surgical approach remains the mainstay of treatment to achieve cure. We believe that the extent of dissection is different in each subgroup and, therefore, the need exists to redefine level III thrombus of the inferior vena cava. The application of liver transplant techniques for mobilizing the liver off of the inferior vena cava as well as the inferior vena cava off of the posterior abdominal wall contributes to excellent exposure and enables adequate vascular control of the inferior vena cava.
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Affiliation(s)
- Gaetano Ciancio
- Department of Surgery, Division of Transpalntation, University of Miami School of Medicine, Floria, USA
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Chesson JP, Theodorescu D. Adrenal tumor with caval extension--case report and review of the literature. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2002; 36:71-3. [PMID: 12002362 DOI: 10.1080/003655902317259409] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Extension of adrenal cortical carcinomas into the IVC is rare. We describe one such tumor that extended to the level of the right atrium. In an effort to aid recognition and guide work-up of an upper pole lesion, we review the literature comprised of 77 similar cases and analyze the data in terms of patient demographics, anatomic distribution, clinical and laboratory evidence of endocrine function. Our review suggests that over half of all adrenal lesions with IVC extension will be clinically nonfunctional, including up to 17% of pheochromocytomas.
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Affiliation(s)
- John P Chesson
- Department of Urology, University of Virginia Health Sciences Center, Charlottesville 22908, USA
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11
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Brizard CP, Goussef N, Chachques JC, Carpentier AF. Model of complete separation of the hepatic veins from the systemic venous system. Ann Thorac Surg 2000; 70:2096-101. [PMID: 11156127 DOI: 10.1016/s0003-4975(00)01528-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In patients undergoing a Fontan operation, partial diversion of the hepatic veins to the pulmonary venous atrium has been tried with various techniques. They failed because of the development of intrahepatic collaterals leading to an unacceptable right-to-left shunting. We postulate that to avoid the formation of intrahepatic collaterals, the totality of the liver has to be drained into the same pressure compartment. We have designed a model of cavopulmonary anastomosis in which a prosthetic conduit reproduces an azygos continuation, associated with the diversion of the totality of the hepatic venous return. This article reports on the early hemodynamics and the fate of the separation of the two venous compartments in long-term survivors. METHODS Eighteen goats were operated on; the pulmonary artery and hepatic vein pressures were recorded. During month 2, an opacification of the inferior vena cava and the cavopulmonary connection was performed. Between months 6 and 14, another opacification was performed, together with pressure recording at both ends of the conduit. RESULTS Postoperatively the pulmonary artery pressure was pulsatile with a mean of 10 mm Hg and the hepatic vein pressure was 0 mm Hg. The first angiogram showed patent tubes with fast progression of the contrast. Throughout the inferior vena cava injection, there was no opacification of the portal or hepatic veins. The late study showed a narrowed conduit in all animals. During the injection, a collateral was injected, feeding into the inferior mesenteric vein. No collateral circulation could be seen draining directly into the liver. The median gradient between the two ends of the conduit was 11 mm Hg. CONCLUSIONS The isolation of the entire hepatic venous drainage is feasible and efficient for the separation of two pressure compartments. No intrahepatic collaterals are observed with this model at short- or long-term follow-up. The separation of the hepatic venous drainage should persist without collateral circulation as long as the inferior vena cava pressure stays at the levels observed in Fontan circulation.
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Affiliation(s)
- C P Brizard
- Laboratoire d'etude des Greffes et Prothèses Cardiaques, H pital Broussais, Paris, France.
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Akimaru K, Onda M, Tajiri T, Yoshida H, Mamada Y, Taniai N, Yoshioka M, Mineta S. Reconstruction of the vena cava with the peritoneum. Am J Surg 2000; 179:289-93. [PMID: 10875988 DOI: 10.1016/s0002-9610(00)00332-9] [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: 10/18/2022]
Abstract
BACKGROUND Reconstruction of the vena cava with an autologous vein requires extra incisions. Prosthetic material is associated with an increased risk of infection. We therefore created an animal model of vena cava reconstruction using the peritoneum. METHODS A 2.5 x 2.5 cm piece of peritoneum was resected from 7 pigs weighing 30 to 40 kg. An oval window (long axis: 1.5 cm) was made in the infrarenal vena cava. This was repaired with the peritoneal patch fixed in alcohol. RESULTS In 2 animals sacrificed at 5 hours, there was no evidence of thrombosis, but there was fibrin clot on the patches. Two animals sacrificed on day 8 exhibited excellent patency of the vena cava. Complete endothelialization of the patch was noted at day 15. At 6 weeks, the vena cava was healed. No infections or other problems were noted. CONCLUSIONS The peritoneum is an accessible and safe substitute for reconstruction of the vena cava.
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Affiliation(s)
- K Akimaru
- First Department of Surgery, Nippon Medical School, Tokyo, Japan
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13
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Mondragón-Sánchez R, Orellana H, Bernal-Maldonado R, Ruíz-Molina JM. Resection of tumors of the pararenal inferior vena cava with in situ perfusion of the right kidney and graft replacement with bovine pericardium. J Am Coll Surg 1998; 186:717-9. [PMID: 9632161 DOI: 10.1016/s1072-7515(98)00098-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Mondragón-Sánchez
- Department of Gastroenterology, The National Institute of Cancerology, Mexico City, Mexico
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14
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Tajima T, Yoshimitsu K, Honda H, Kuroiwa T, Irie H, Makisumi K, Masuda K, Abe Y, Naitou S. Hypervascular renal transitional cell carcinoma with extension into the renal vein and inferior vena cava. Comput Med Imaging Graph 1997; 21:365-8. [PMID: 9690013 DOI: 10.1016/s0895-6111(97)00034-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A rare case of transitional cell carcinoma (TCC) with extension into the renal vein and inferior vena cava (IVC) is presented. Computed tomography, magnetic resonance imaging, and angiography successfully delineated tumor thrombus in the right renal vein and IVC. TCC should be included in the differential diagnosis of renal tumors that can cause IVC thrombosis.
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Affiliation(s)
- T Tajima
- Department of Radiology, Faculty of Medicine, Kyushu University Hospital, Fukuoka, Japan
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Isaka S, Okano T, Shimazaki J, Masuda M, Miyazaki M. Surgical approach to tumor thrombus of renal cell carcinoma at the level between hepatic vein and diaphragm. Int J Urol 1997; 4:13-6. [PMID: 9179660 DOI: 10.1111/j.1442-2042.1997.tb00131.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The curative resection of tumor thrombus of renal cell carcinoma often provides a good prognosis, but the best surgical method for resection at the level between hepatic vein and diaphragm is still a matter of controversy. METHODS We performed transabdominal surgery without cardio-pulmonary bypass on 4 patients with tumor thrombus at the level between hepatic vein and diaphragm. The surgical procedures were as follows: The right lobe of the liver was separated and detached from the retroperitoneum, and then the vena cava was clamped just below the diaphragm simultaneous with clamping the porta hepatis. After complete circulatory isolation of the vena cava, the tumor thrombus was resected. RESULTS There were no severe complications postoperatively. Two patients died of cancer 18 and 38 months after surgery, and the other 2 are alive without evidence of disease after 62 and 66 months. CONCLUSION This anatomically rational approach is thought to be a good alternative to the pull-through method or cardio-pulmonary bypass for removing a tumor thrombus at this level.
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Affiliation(s)
- S Isaka
- Department of Urology and Surgery, School of Medicine, Chiba University, Japan
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Okada Y, Kumada K, Terachi T, Nishimura K, Tomoyoshi T, Yoshida O. Long-term Followup of Patients with Tumor Thrombi from Renal Cell Carcinoma and Total Replacement of the Inferior Vena Cava Using an Expanded Polytetrafluoroethylene Tubular Graft. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66413-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yusaku Okada
- Departments of Urology and Second Surgery, Faculty of Medicine, Kyoto University, Kyoto, and Shiga University of Medical Science, Shiga, Japan
| | - Kaoru Kumada
- Departments of Urology and Second Surgery, Faculty of Medicine, Kyoto University, Kyoto, and Shiga University of Medical Science, Shiga, Japan
| | - Toshiro Terachi
- Departments of Urology and Second Surgery, Faculty of Medicine, Kyoto University, Kyoto, and Shiga University of Medical Science, Shiga, Japan
| | - Kazuo Nishimura
- Departments of Urology and Second Surgery, Faculty of Medicine, Kyoto University, Kyoto, and Shiga University of Medical Science, Shiga, Japan
| | - Tadao Tomoyoshi
- Departments of Urology and Second Surgery, Faculty of Medicine, Kyoto University, Kyoto, and Shiga University of Medical Science, Shiga, Japan
| | - Osamu Yoshida
- Departments of Urology and Second Surgery, Faculty of Medicine, Kyoto University, Kyoto, and Shiga University of Medical Science, Shiga, Japan
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Long-term Followup of Patients with Tumor Thrombi from Renal Cell Carcinoma and Total Replacement of the Inferior Vena Cava Using an Expanded Polytetrafluoroethylene Tubular Graft. J Urol 1996. [DOI: 10.1097/00005392-199602000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wei CY, Chen KK, Chen MT, Lai HT, Chang LS. Adrenal cortical carcinoma with tumor thrombus invasion of inferior vena cava. Urology 1995; 45:1052-4. [PMID: 7771009 DOI: 10.1016/s0090-4295(99)80131-9] [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]
Abstract
A case of adrenal cortical carcinoma with inferior vena cava (IVC) involvement is presented. Ultrasonography, computed tomography, and venacavography all presumptively showed a large mass over the upper pole of the left kidney with tumor thrombus in the IVC. However, aortography demonstrated that this mass was receiving its blood supply from the left inferior phrenic artery, aorta, and left renal artery. Radical surgery, including resection of the tumor and its adjacent organs (kidney, distal pancreas, spleen) and the tumor thrombus in the IVC, with the aid of cardiopulmonary bypass, was performed. We emphasize that adrenal cortical carcinoma can have tumor thrombi invading the IVC, and in such cases we suggest radical surgical removal of the tumor and the thrombus.
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Affiliation(s)
- C Y Wei
- Department of Surgery, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Mingoli A, Cavallaro A, Feldhaus RJ, di Marzo L, Morelli MM, Sciacca V. Inferior vena cava leiomyosarcoma: establishment of an international registry. EUROPEAN JOURNAL OF VASCULAR SURGERY 1994; 8:380-1. [PMID: 8013698 DOI: 10.1016/s0950-821x(05)80166-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
The ultrastructural features of 30 adrenal cortical carcinomas have been reviewed and compared with those seen in adrenal cortical adenomas, adrenal cortical hyperplasia, and the normal cortex. A broad range of ultrastructural appearances was found among the carcinomas, but the differences were mainly in the amount of cytoplasmic lipid, number of lysosomes, and quantity and architecture of the mitochondria and endoplasmic reticulum. Structural variants among the carcinomas included lipid-rich, oncocytic, and glycogen-rich cells. Electron microscopy can be extremely useful in differential diagnoses that include adrenal cortical carcinoma.
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Affiliation(s)
- B Mackay
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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21
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Pasic M, Senning A, Segesser LV, Carrel T, Turina M. Transcaval liver resection with hepatoatrial anastomosis for treatment of patients with the Budd-Chiari syndrome. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)34126-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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23
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Janosko EO, Powell CS, Spence PA, Hodges WE, Lust RM. Surgical management of renal cell carcinoma with extensive intracaval involvement using a venous bypass system suitable for rapid conversion to total cardiopulmonary bypass. J Urol 1991; 145:555-7. [PMID: 1997709 DOI: 10.1016/s0022-5347(17)38395-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Renal cell carcinoma involves the vena cava in approximately 4% of the patients. Presently surgical extirpation is the only form of therapy that can result in cure. Recently management of extensive vena caval involvement has involved the use of cardiopulmonary bypass with circulatory arrest and hypothermia. We describe a technique using a venous bypass pump system (femoral vein to right atrium) for resection of renal cell carcinoma with suprahepatic vena caval extension (type II), which avoids the risks and complications of cardiac arrest and hypothermia but allows for rapid conversion to total cardiopulmonary bypass should the intraoperative need arise.
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Affiliation(s)
- E O Janosko
- Division of Urology, Vascular and Cardiothoracic Surgery, Pitt County Memorial Hospital, Greenville, North Carolina
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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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25
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Okada Y, Kumada K, Habuchi T, Ohnishi H, Nishimura K, Yoshida O. Total replacement of the suprarenal inferior vena cava with an expanded polytetrafluoroethylene tube graft in 2 patients with tumor thrombi from renal cell carcinoma. J Urol 1989; 141:111-4. [PMID: 2908931 DOI: 10.1016/s0022-5347(17)40609-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Total replacement of the suprarenal inferior vena cava using an expanded polytetrafluoroethylene vascular graft was successful in 2 renal cell carcinoma patients with extended tumor thrombi densely adherent to the vena caval wall. Right radical nephrectomy in 1 patient and enucleation of the tumor in the solitary right kidney were performed concomitantly. Both patients are well without tumor recurrence and with good vena caval patency 14 and 6 months postoperatively. This procedure could be a safer mode of operation in cases of extended vena caval involvement by malignant tumors. Total reconstruction of the inferior vena cava enables more radical resection of the tumor.
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Affiliation(s)
- Y Okada
- Department of Urology, Faculty of Medicine, Kyoto University, Japan
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Bintz M, Cogbill TH, Klein A. Surgical treatment of renal cell carcinoma involving the inferior vena cava. J Vasc Surg 1987. [DOI: 10.1016/0741-5214(87)90272-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Taylor RW, Sylwestrowicz T, Kossakowska AE, Urbanski SJ, Minuk GY. Leiomyosarcoma of the inferior vena cava presenting as Budd-Chiari syndrome. LIVER 1987; 7:201-5. [PMID: 3683091 DOI: 10.1111/j.1600-0676.1987.tb00343.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of a 72-year-old male with a leiomyosarcoma of the inferior vena cava causing Budd-Chiari syndrome is described. Percutaneous decompression of the portal system was attempted but with no success. At autopsy, a large tumor arising from and completely obstructing the inferior vena cava was found, histologically proven to be a leiomyosarcoma. Over 50 cases of leiomyosarcoma of the inferior vena cava have been reported in the literature, the majority of which occurred in women and 1/3 of which were associated with the Budd-Chiari syndrome. Histologically up to two mitotic figures per 10 high power fields have been scored. This case indicates the unreliability of a low mitotic index as an indicator of benign behavior of smooth muscle neoplasms of the venous system.
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Affiliation(s)
- R W Taylor
- Department of Pathology, Foothills Hospital, Calgary, Alberta, Canada
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Brabrand K, Søreide JA. Adrenal cortical carcinoma with invasion into the inferior vena cava. Br J Surg 1987; 74:598-9. [PMID: 3620869 DOI: 10.1002/bjs.1800740719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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29
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Abstract
We report a case of metastatic seminoma that caused thrombosis and obstruction of the inferior vena cava. The pathogenesis of this rare clinical entity is discussed. The diagnostic studies for detection of vena caval thrombosis and clinical management strategies are reviewed.
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30
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Selective surgical therapy of the Budd-Chiari syndrome provides superior survivor rates than conservative medical management. J Vasc Surg 1987. [DOI: 10.1016/0741-5214(87)90191-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Andréen T, Aberg T, Fritjofsson A. Surgery of renal cancer with extensive caval invasion. Suggestion for a new approach. Ups J Med Sci 1985; 90:107-14. [PMID: 3909590 DOI: 10.3109/03009738509178646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Radical surgery for renal cancer with invasion of the inferior vena cava can improve the patient's quality of life and, in some cases, offer longer survival or even cure. With a carefully planned surgical approach it is possible to remove renal tumours with thrombotic extension to the most proximal part of the inferior vena cava without necessity for cardiopulmonary bypass and without undue risk to the patient. In the operative procedure, good access and visual control of the proximal vena cava and all the contributing veins seem to be crucially important.
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