Unusual presentation of testicular cancer with tumor thrombus extending to the inferior vena cava

Case Report: Multidisciplinary discussion and management of a case involving a non-seminomatous germ cell tumor complicated by the presence of cancerous thrombus in the inferior vena cava

Testicular cancer predominantly manifests in younger males. It demonstrates a favorable response to cisplatin-based chemotherapy and exhibits a promising overall survival. Nevertheless, the emergence of certain rare complications, such as the development of an embolus in the vena cava due to cancer, suggests that the tumor exhibits a high degree of aggressiveness and is associated with a poorer prognosis. We present a case of stage IIIC mixed malignant germinoma with metastases to both lungs, left kidney, right paravascular iliac lymph nodes, periaortic lymph nodes, and an inferior vena cava tumor thrombus. Following Multi-disciplinary Team (MDT) discussion, treatment modalities including surgery and adjuvant chemotherapy were devised, resulting in optimal therapeutic outcomes without complications or significant adverse reactions.

Between the Devil and the Deep Sea-The Cardiac Conundrum: Report of a Contiguous Cavo-Atrial Tumor Thrombus in NSGCT Testis

Testicular cancer is notorious for its myriad presentations. In this case report, we present a 28-year-old gentleman diagnosed with metastatic non-seminomatous germ cell tumor (NSGCT). After receiving neoadjuvant chemotherapy, he was found to have a large paracaval conglomerate nodal mass infiltrating the inferior vena cava (IVC), with a contiguous thrombus extending from the vena cava to the right atrium. The pre-operative imaging was ambiguous, with the cavo-atrial thrombus appearing to float within the vascular lumen at some places and infiltrating the caval wall at others. Hence, arrangements were made for cardiopulmonary bypass, sternotomy, and vascular surgeon backup. Intraoperatively, the vena cava was palpated in its entirety up to the mediastinum, and the thrombus was found to be freely floating. Hence, the thrombus was milked out in its entirety from the right atrium up to the vena cava, and the paracaval mass was resected en bloc with the tumor thrombus. The IVC was reconstructed with a Dacron graft. A review of the literature revealed no previously documented cases of contiguous cavo-atrial tumor thrombus. Approaching cases requires an assessment of the nature of the thrombus and the need to prepare for the worst. It is worth remembering that going the extra mile concerning obtaining a complete tumor clearance is worth it in NSGCTs, given the highly gratifying outcomes.

Rare Presentation of Testicular Cancer With Malignant Tumor Thrombus: A Case Report

In rare cases, testicular cancer can metastasize to the inferior vena cava (IVC) through a tumor thrombus, significantly worsening the prognosis. This case report describes the management and the outcome of a rare presentation of testicular cancer. A 38-year-old male presented with a testicular mass and was found to have a mixed germ cell tumor with predominantly yolk sac components. Imaging after the initial orchiectomy revealed an IVC tumor thrombus extending from the left renal vein, as well as retroperitoneal and pulmonary metastases. The patient was urgently started on anticoagulation and underwent three cycles of BEP chemotherapy (bleomycin, etoposide, and cisplatin), which led to complete metabolic and radiographic regression of the metastatic disease.

A Case of Non-Seminomatous Germ Cell Tumor Complicated by Tumor Thrombus in an Active Duty Soldier

Testicular malignancies commonly affect adolescent and young adult males. Although they tend to respond well to cisplatin-based chemotherapy with excellent overall survival, complications such as inferior vena cava tumor thrombus are rare and can be associated with high morbidity and mortality. We present a case of tumor thrombus in a 21-year-old active duty male with a newly diagnosed stage IIIB non-seminomatous germ cell tumor presenting with extensive left lower extremity swelling. Ultrasound with Doppler was notable for significant thrombus of the left common femoral, femoral, and popliteal vein. Computed tomography imaging revealed extensive thrombus of the inferior vena cava, left iliac veins, and left gonadal vein with sparing of the left renal vein. Endovascular thrombectomy was performed with pathologic analysis confirming the presence of malignant cells consistent with tumor thrombus. The patient continued subsequent non-seminomatous germ cell tumor treatment without complications.

Testicular cancer with extensive gonadal and renal vein tumor thrombus

Tumor thrombus has been demonstrated to occur with hepatocellular and renal cell carcinoma, however, rarely occurs in testicular germ cell malignancies. Tumor thrombus results from the intravascular invasion of malignant cells, different from the hypercoagulable state induced by malignancy, and has significant implications with regards to prognosis and therapeutic options. We describe a case of an otherwise healthy 30-year-old patient with extensive gonadal and renal vein tumor thrombus from testicular germ cell cancer, as well as discuss the diagnosis and treatment options for this type of metastatic disease.

Tumor thrombus: incidence, imaging, prognosis and treatment

Intravascular tumor extension, also known as tumor thrombus, can occur in many different types of cancer. Those with the highest proclivity include Wilm's tumor, renal cell carcinoma (RCC), adrenal cortical carcinoma (ACC) and hepatocellular carcinoma (HCC). The presence of tumor thrombus markedly worsens prognosis and impacts treatment approach. Imaging plays a key role in its diagnosis. Endovascular methods also play a large role in treatment.

Pure Yolk sac presenting with inferior vena cava thrombus extending from bilateral external iliac veins to hepatic vein

Introduction:

Vena cava thrombus is an extremely rare complication of testicular tumors. We report on an unusual case of testicular tumor presenting with inferior vena cava thrombus extending from the left spermatic and bilateral external iliac veins to the hepatic vein.

Case report:

A-35-year old man presented with a 6-month history of left scrotal mass and a 1-day history of bilateral lower extremity edema. Computed tomography (CT) revealed the presence of thrombus extending from the left spermatic vein and bilateral external iliac veins to the hepatic vein, and multiple lymph node and lung metastases. 3 cycles of chemotherapy were given after the left high inguinal orchiectomy. Pathological examination demonstrated a pure yolk sac carcinoma with lymphovascular invasion and direct tumor extension into the left spermatic cord. CT and positron emission tompgraphy-CT obtained no findings of metastasis or recurrence at 3 months after the chemotherapy.

Conclusion:

We review this seldom case and discuss the literature with regard to its diagnosis and treatment.