Pulmonary Hypertension due to Isolated Metastatic Squamous Cell Carcinoma Thromboemboli

A rare case of renal angiomyolipoma involved both inferior vena cava and pulmonary arteries

Angiomyolipoma is a benign mesenchymal tumour, which rarely involve inferior vena cava (IVC) and pulmonary arteries. Here we reported a 41-year-old man, who presented symptoms of chronic pulmonary embolism. After multiple images evaluation, a large tumour with the same properties as the pulmonary embolism was found in the right kidney. One-staged surgery to remove both pulmonary embolism and right kidney was performed. Histological study showed the tumour and embolism as angiomyolipoma. The present study reported a rare case with renal angiomyolipoma and both IVC and pulmonary arteries involvements, which provided a good example for differential diagnosis in the emergency department and treating a rare type of chronic pulmonary embolism after renal angiomyolipoma.

Concomitant surgery for renal neoplasm with pulmonary tumor embolism

OBJECTIVE

Gross tumor pulmonary embolism from renal carcinoma is rarely diagnosed preoperatively. Individual cases of intraoperative embolization of tumor during radical resection of the kidney have been reported. We report on 9 patients who underwent pulmonary arterial tumor removal concomitant with nephrectomy.

METHODS

Between 2000 and 2008, 9 patients underwent simultaneous nephrectomy and removal of gross embolic tumor from the pulmonary arteries. In 7 of these patients the diagnosis was made preoperatively by either computed tomography or magnetic resonance imaging. Cardiopulmonary bypass was used in all cases. Bilateral removal of pulmonary artery tumor was required in 7 patients and unilateral in 2.

RESULTS

All patients survived to hospital discharge after a median stay of 8.8 days (mean, 6-17 days). Two patients are currently alive 4 and 56 months after the operation. Six patients died of distant metastasis or local recurrence of disease after 6, 9, 12, 17, 25, and 29 months. Actuarial survival at 6 months, 1, 2, and 3 years was 100%, 75%, 50%, and 25%, respectively.

CONCLUSIONS

Pulmonary artery embolic tumor removal concomitant with nephrectomy for renal carcinoma can be performed safely. Survival of patients with combined surgery is comparable with that of patients with the same stage of renal neoplasm without pulmonary tumor embolism. The pulmonary tumor embolism in patients with renal carcinoma should be considered as extension of vena caval tumor but not as a distant metastasis. Pulmonary tumor removal provides symptomatic relief and may provide a survival benefit in these patients.

Pulmonary hypertension in older adults

Pulmonary hypertension is a frequently encountered problem in older patients. True idiopathic pulmonary arterial hypertension can also be seen and requires careful exclusion in older patients. Institution of therapies must be tempered with an appreciation of individual comorbidities and functional limitations that may affect patients' ability to comply and benefit from the complex treatments available for pulmonary arterial hypertension. This article reviews the existing data on the various forms of pulmonary hypertension presenting in older patients and on appropriate therapy in this challenging population.