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Nahas MA, Samha R, Shbat M, Ghaddar SA, Jobran AWM, Msheik L, Al nahhas Z, Chaban H. Wide en-bloc thymectomy and venous axis reconstruction in Masaoka stage IIIB thymoma: a case report and literature review. J Surg Case Rep 2024; 2024:rjae263. [PMID: 38706480 PMCID: PMC11066797 DOI: 10.1093/jscr/rjae263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Thymomas are rare tumors originating from thymic tissue and rarely metastasize. They can be diagnosed either incidentally or symptomatically when compressing or invading nearby structure. A 36-year-old man presented with significant high-grade fever, chest pain that worsens upon lying down, and dyspnea. A chest X-Ray and computed tomography followed by biopsy confirmed the diagnosis of thymoma. The management included chemotherapy cycles, followed by surgery. Pericardiectomy was performed with en-bloc thymectomy and partial resection of the infiltrating lung. Venous drainage was restored by 8/16 mm inverted bifurcated brachiocephalic-superior vena cava Dacron bypass. The pericardium was reconstructed by a synthetic Dacron patch, and the right diaphragm metastasis was resected. Neoadjuvant chemotherapy was initiated. After 3 months of follow-up, no recurrence was evidenced by computed tomography.
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Affiliation(s)
- Mohamad A Nahas
- Division of Vascular and Endovascular Surgery, AlAssad Damascus University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Raghad Samha
- Faculty of Medicine, AlBaath University, Homs, Syrian Arab Republic
| | - Mohamad Shbat
- Department of Thoracic Surgery, Al-Assad university Hospital, Damascus, Syria
| | | | | | - Layal Msheik
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Zaher Al nahhas
- Department of Radiology, Damascus hospital, Damascus, Syrian Arab Republic
| | - Hussain Chaban
- Department of Thoracic Surgery, Al-Assad university Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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2
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Laddha A, Bijalwan P, Thomas A, Kumar P G. Small Renal Mass with Level 4 IVC Thrombus. Indian J Surg Oncol 2019; 10:196-198. [PMID: 30948898 DOI: 10.1007/s13193-018-0835-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Abhishek Laddha
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
| | - Priyank Bijalwan
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
| | - Appu Thomas
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
| | - Ginil Kumar P
- Department of Urology, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara P.0, Kochi, Kerala 682041 India
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3
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Gulia A, Puri A, Byregowda S, Rekhi B, Laskar S, Shetty N. Inferior Vena Caval Tumor Thrombus in Giant Cell Tumor of Sacrum - An Unusual Complication Treated with Multimodality Management. J Orthop Case Rep 2016; 5:54-6. [PMID: 27299100 PMCID: PMC4845458 DOI: 10.13107/jocr.2250-0685.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Giant cell tumor is the most common benign lesion encountered. It accounts for 5 % of all skeletal tumors. It mainly affects the epiphysis of long bones and rarely axial bones. In axial bones, sacrum is the most common site to be affected. CASE REPORT A 23 year old female with giant cell tumor of sacrum was treated initially with conservative treatment (serial angioembolisation and bisphosphonates). Later intralesional curettage was done as the patient started developing bladder and bowel disturbances after two sessions of angioembolisation. Six months later patient again presented with pain at the primary lesion site and bilateral limb swelling. Imaging revealed recurrence of the disease and tumor thrombus extending into the inferior vena cava up to the subhepatic region. CONCLUSION Treatment of sacral GCT (Giant Cell Tumor) poses a unique challenge to the treating surgeon because of the close proximity of vital neurovascular structures, viscera and associated complications related to the disease. Tumor thrombi are a very rare phenomenon associated with giant cell tumors of the bone. High index of suspicion and multimodality approach is the key in treating such challenging tumors and their complications.
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Affiliation(s)
- Ashish Gulia
- Department of surgical oncology, Tata Memorial Centre, Mumbai, India
| | - Ajay Puri
- Department of surgical oncology, Tata Memorial Centre, Mumbai, India
| | - Suman Byregowda
- Department of surgical oncology, Tata Memorial Centre, Mumbai, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Siddhartha Laskar
- Department of Raditaion Oncology, Tata Memorial Centre, Mumbai, India
| | - Nitin Shetty
- Department of Intervention Radiology, Tata Memorial Centre, Mumbai, India
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4
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Li X, Xiao F, Yang Y, He Y, Zhang S. One-stage complete resection of giant intracardiac leiomyomatosis with moderate hypothermia extracorporeal circulation and beating heart technique with 36 months follow-up-a case report. J Cardiothorac Surg 2016; 11:64. [PMID: 27072649 PMCID: PMC4830041 DOI: 10.1186/s13019-016-0445-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intracardiac leiomyomatosis (ICL) is a rare benign neoplasm of the smooth muscle in the uterus extending into the heart. Complete resection is difficult because of the extensive range. CASE PRESENTATION We report a case of one-stage complete resection of a giant ICL with moderate hypothermia extracorporeal circulation and beating heart technique. CONCLUSIONS The outcome of 36 months follow-up was very good.
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Affiliation(s)
- Xihui Li
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China.
| | - Feng Xiao
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yindong He
- Department of Gynaecology, Peking University First Hospital, Beijing, China
| | - Siyu Zhang
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China
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5
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Clay TD, Dimitriou J, McNally OM, Russell PA, Newcomb AE, Wilson AM. Intravenous leiomyomatosis with intracardiac extension - a review of diagnosis and management with an illustrative case. Surg Oncol 2013; 22:e44-52. [PMID: 23642379 DOI: 10.1016/j.suronc.2013.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/05/2013] [Accepted: 03/27/2013] [Indexed: 12/01/2022]
Abstract
Intravenous leiomyomatosis with intracardiac extension is an uncommon pathologic progression of uterine leiomyomata. It is a histologically benign condition, however due to interfence with right sided cardiac function patients may present with marked cardiovascular compromise and present a diagnostic dilemma to clinicians who are unfamiliar with this condition. Given the rarity of this condition, experience in individual institutions is usually limited to a few cases. We present an illustrative case and provide a review of the clinical presentation, preoperative assessment, operative approach, pathology and postoperative issues. The importance of a multidisciplinary approach to diagnosis and management is highlighted. Operative management aims to completely resect all tumour in the safest manner for the patient, most commonly via single or two stage operation. Where complete resection is achieved, recurrence appears to be a rare event.
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Affiliation(s)
- Timothy D Clay
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia.
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6
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Kurata A, Saji H, Ikeda N, Kuroda M. Intracaval and intracardiac extension of invasive thymoma complicated by superior and inferior vena cava syndrome. Pathol Int 2013; 63:56-62. [PMID: 23356226 DOI: 10.1111/pin.12023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/24/2012] [Indexed: 11/28/2022]
Abstract
We present a case of an aged male with invasive thymoma that extended into the right atrium and led to superior and inferior vena cava syndrome. The patient initially presented with edema of the face and bilateral lower extremities. Echocardiography revealed a mass within the right atrium. Imaging studies demonstrated an anterior mediastinal tumor that continuously occupied the bilateral brachiocephalic veins, superior vena cava, and right atrium. Pathological diagnosis of the tumor biopsy was highly suspicious of thymoma. Due to the high risk of wide spread of the tumor, treatments including resection of the tumor were impossible. Several days later he died, and an autopsy was performed. The tumor was type B2 thymoma invading bilateral brachiocephalic veins, superior vena cava and right atrium. Multiple tumor emboli within the pulmonary arteries were identified. Direct cause of death was deemed to be tumor strangulation at the tricuspid orifice. In addition to the superior vena cava syndrome, inferior vena cava syndrome including ectasia of the intrahepatic vessels was confirmed along with pericarditis. To our knowledge, this is the first English report of an autopsy case of intracardiac thymoma extension, and a detailed literature review of similar cases is also presented.
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Affiliation(s)
- Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan.
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7
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Rajaii-Khorasani A, Kahrom M, Hashemzadeh M, Tayebi S, Ghazi M, Hamedanchi A. Pulmonary artery extension of uterine leiomyoma. J Card Surg 2012; 27:466-9. [PMID: 22640175 DOI: 10.1111/j.1540-8191.2012.01469.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intravenous leiomyomatosis is a rare tumor arising either from a uterine leiomyoma or from uterine vessel walls with extension into venous channels. Although intravenous leiomyomatosis is considered histologically "benign," intrusion to the cardiac chambers is almost malignant given its possibility for destruction of heart valves, extending into the pulmonary vasculature, and embolizing. We report a patient with an intravenous leiomyomatosis progressing through the left iliac vein, along the entire vena cava up to the right cardiac chambers and branches of pulmonary artery (PA), and review the literature on this subject.
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8
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Gooskens SLM, Furtwängler R, Vujanic GM, Dome JS, Graf N, van den Heuvel-Eibrink MM. Clear cell sarcoma of the kidney: a review. Eur J Cancer 2012; 48:2219-26. [PMID: 22579455 DOI: 10.1016/j.ejca.2012.04.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/29/2012] [Accepted: 04/16/2012] [Indexed: 02/07/2023]
Abstract
Clear cell sarcoma of the kidney (CCSK) is a rare renal tumour that is observed most often in children under 3years of age. Only a few large series of CCSK have been reported and patients with CCSK are often included among patients with other types of childhood renal tumours. The purpose of this paper is to review the published series and case reports of CCSK and to create an up-to-date overview of clinical and histological features, genetics, treatment, and outcome.
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Affiliation(s)
- S L M Gooskens
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
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9
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Successful one-stage surgical removal of intravenous leiomyomatosis with cardiac extension in an elderly patient. Gen Thorac Cardiovasc Surg 2012; 60:153-6. [DOI: 10.1007/s11748-011-0791-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/09/2011] [Indexed: 10/28/2022]
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10
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Strategy for management of retroperitoneal tumors with caval tumor thrombus. J Pediatr Surg 2011; 46:2065-70. [PMID: 22075334 DOI: 10.1016/j.jpedsurg.2011.06.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/08/2011] [Accepted: 06/25/2011] [Indexed: 11/23/2022]
Abstract
The surgical management of retroperitoneal tumors extending into the inferior vena cava (IVC) can be challenging. Although Wilms' tumor is the most common retroperitoneal tumor extending into the IVC, one must approach these tumors systematically as other diagnoses are possible. We present 4 consecutive cases of retroperitoneal tumors with IVC extension as a basis for a management strategy in approaching these patients. Despite similar presentations, these cases illustrate the nuances in surgical management and need for multidisciplinary care with the pediatric oncologists, pediatric surgeons, and pediatric cardiac surgeons.
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11
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Luciani N, Anselmi A, Glieca F, Martinelli L, Possati G. Diagnostic and surgical issues in emergency presentation of a pelvic leiomyoma in the right heart. Ann Thorac Surg 2009; 87:1589-92. [PMID: 19379915 DOI: 10.1016/j.athoracsur.2008.09.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 09/28/2008] [Accepted: 09/30/2008] [Indexed: 11/25/2022]
Abstract
A computed tomography scan in a 43-year-old woman with a nonsignificant previous medical history demonstrated an inferior caval mass prolapsing through the right atrium and the tricuspid valve. The mass was misdiagnosed as a thrombus-in-transit, and heparin was started. The clinical picture suddenly evolved into cardiogenic shock, and the patient underwent an emergency resection of the intracardiac portion of the mass. Macroscopic and microscopic features were consistent with leiomyoma. In the presence of an inferior caval mass, historical elements and computed tomography imaging that do not corroborate the hypothesis of caval thrombosis should raise the suspicion of intracaval tumor originating from an abdominal or pelvic organ. The preferred treatment strategy is an elective combined thoracic and abdominal resection.
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Affiliation(s)
- Nicola Luciani
- Division of Cardiac Surgery, Catholic University, Rome, Italy
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12
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Abstract
Clear cell sarcoma is one of the rarely occurring renal tumors during childhood, and transvenous tumor extension into the right atrium is even more unusual. In this report, we describe the presentation, treatment, technique of complete resection, and outcome of a 23-month-old girl with clear cell sarcoma of the right kidney with cavo-atrial tumor thrombus.
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Affiliation(s)
- Andrew Zigman
- Division of Pediatric Surgery, Northwest Permanente, Portland, OR 97225, USA.
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13
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Abstract
Intracardiac tumors are unusual and can originate within the heart or spread from other sites. This is a report of a patient who presented with a TIA, and during the subsequent stroke workup, a right hilar nonsmall cell lung carcinoma was discovered. The tumor had extended into the left atrium through a pulmonary vein. The hilar tumor as well as intracardiac extension were demonstrated by PET scanning using FDG.
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Affiliation(s)
- Gary F Gates
- Nuclear Medicine Department, Providence St. Vincent Medical Center, Portland, OR 97225, USA.
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14
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Rohani M, Roumina S, Saha SK. Renal adenocarcinoma with intramyopericardial and right atrial metastasis, latter via coronary sinus: report of a case. Echocardiography 2005; 22:345-8. [PMID: 15839992 DOI: 10.1111/j.1540-8175.2005.04068.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary renal tumors with intracardiac metastasis are not infrequent. Most of the secondary spread is blood-borne and occurs via inferior vena cava. Patients with such a spread often present with cardiac symptoms. We presume that a metastatic spread in the right atrium through coronary sinus has never been reported in the literature according to the result of a Medline search at the time of writing this report.
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Affiliation(s)
- Morteza Rohani
- Karolinska University Hospital, Huddinge, Stockholm, Sweden
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15
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Thukkani N, Ravichandran PS, Das A, Slater MS. Leiomyomatosis Metastatic to the Tricuspid Valve Complicated by Pelvic Hemorrhage. Ann Thorac Surg 2005; 79:707-9. [PMID: 15680873 DOI: 10.1016/j.athoracsur.2003.08.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2003] [Indexed: 11/30/2022]
Abstract
Metastatic leiomyomatosis is a rare but potentially life-threatening tumor of smooth muscle cells. Leiomyomas originate predominantly in the uterus and can spread to the lung and, rarely, the heart. We present a case of a 36-year-old woman with known pelvic leiomyomatosis with metastasis to the tricuspid valve. Tricuspid valve replacement was complicated by retroperitoneal hemorrhage from residual pelvic tumor. This potentially catastrophic occurrence should be considered when undertaking resection of intracardiac leiomyomatosis.
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Affiliation(s)
- Nundhini Thukkani
- Division of Cardiothoracic Surgery, Oregon Health Sciences University, Portland, Oregon 97201, USA
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16
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Derubertis BG, Clair D, Faries P, Kapur S, Park K, Kent KC. Resection of an intravenous leiomyoma with intracardiac extension with use of endovascular techniques. J Vasc Surg 2004; 40:554-8. [PMID: 15337888 DOI: 10.1016/j.jvs.2004.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intravenous leiomyoma with intracardiac extension is a rare entity that necessitates surgical excision to alleviate symptoms and prevent life-threatening complications. These procedures are generally performed under cardiopulmonary bypass, and review of the literature reveals an evolution in management of this disease from 2-stage to single-stage procedures. We report the case of a 45-year-old woman with an intravenous leiomyoma with intracardiac extension after presenting with syncopal symptoms. The intravenous tumor and its supradiaphragmatic extension were ultimately resected via laparotomy without the need for cardiopulmonary bypass. Distal control was achieved by passing an occluding balloon catheter above the tumor through a venotomy with fluoroscopic guidance and echocardiography, thus enabling protected tumor extraction through the intra-abdominal inferior vena cava. In selected patients, we believe use of endovascular techniques combined with proper preoperative imaging can safely permit single-stage resection of these tumors via laparotomy without cardiopulmonary bypass.
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Affiliation(s)
- Brian G Derubertis
- Division of Vascular Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York 10021, USA
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17
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Nam MS, Jeon MJ, Kim YT, Kim JW, Park KH, Hong YS. Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature. Gynecol Oncol 2003; 89:175-80. [PMID: 12694674 DOI: 10.1016/s0090-8258(02)00138-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravenous leiomyomatosis with intracaval and intracardiac extension has been rarely described in surgical, gynecological, and radiological literatures. Complete excision of the tumor is essential for a favorable outcome. Because of the uniqueness of this tumor having an absent or localized attachment site, its removal is feasible when assisted, prior to surgery, with appropriate imaging and planning. CASE The case was a 46-year-old woman, with intravenous leiomyomatosis originating from the uterus and extending to the inferior vena cava and right atrium, with extensive intracaval attachment, diagnosed from the various preoperative studies and operated successfully through the single-stage approach using cardiopulmonary bypass. CONCLUSION We present an unusual case of intravenous leiomyomatosis originating from the uterus and extending to the inferior vena cava and right atrium with extensive intracaval attachment. We include a brief review of the literatures.
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Affiliation(s)
- Mi Suk Nam
- Department of Obstetrics and Gynecology, BK21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea
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18
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Tsuji Y, Goto A, Hara I, Ataka K, Yamashita C, Okita Y, Kamidono S. Renal cell carcinoma with extension of tumor thrombus into the vena cava: surgical strategy and prognosis. J Vasc Surg 2001; 33:789-96. [PMID: 11296333 DOI: 10.1067/mva.2001.111996] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The outcome of patients who underwent radical resection of renal cell carcinoma extending into the vena cava was retrospectively analyzed, and risk factors for long-term survival were investigated. METHODS From 1983 to 1999, 33 patients who had renal cell carcinoma with inferior vena caval tumor extension underwent 34 surgical procedures. There were 27 men and six women with an average age of 60.1 years. Twenty-two cases (64.7%) were classified as stage III (T1-2 N1 M0 or T3 N0-1 M0), and 12 cases (35.3%) as stage IV (T4 or N2-3 or M1). Coexistent lung metastasis was found in seven cases (20.6%). The tumor thrombi invaded into the inferior vena cava below the hepatic hilum in 19 cases, below the orifice of hepatic veins in 12, and above the diaphragm in 3. Cardiopulmonary bypass graft was applied in 13 cases (38.2%). Inferior vena cava was reconstructed by direct suture (n = 19), polytetrafluoroethylene patch angioplasty (n = 13), or graft replacement (n = 2). RESULTS Two patients died during the early postoperative period because of retrohepatic caval injury and intraoperative pulmonary embolism. Late death occurred in 16 patients; the causes of death were tumor recurrence in 15 and acute pulmonary embolism as a result of graft thrombosis in 1. Overall 1-, 5-, and 10-year survival rates were 70%, 44%, and 26.4%, respectively. One- and 5-year survival rates were 81.3% and 52.9% for stage III and 50% and 31.2% for stage IV; a statistically significant correlation was found between surgical staging and survival (P =.049). Patients without lymph node metastasis had a significant survival advantage over those with lymph node metastasis (P =.022). There was no significant difference in survival on the basis of the presence or absence of synchronous lung metastasis (P =.291). The degree of local extension of the tumor or the level of tumor thrombus did not tend to influence survival. CONCLUSIONS Surgical prognosis in patients with renal cell carcinoma extending into the vena cava was determined by the staging of the tumor, especially lymph node status, and not by the level of tumor thrombus or the presence of concurrent lung metastasis. The use of cardiopulmonary bypass graft is recommended for the resection of tumor thrombus extending over the diaphragm.
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Affiliation(s)
- Y Tsuji
- Department of Surgery, Division II, Kobe University School of Medicine, Japan
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