Adult neuroblastoma of the adrenal with intraatrial tumor thrombus: report of a case

A case of adult neuroblastoma of the right adrenal with tumor thrombus extending into the right atrium is reported. Because of right heart failure, the tumor thrombus in the right atrium was removed under the cardiopulmonary bypass. The histopathological examination of the tumor thrombus revealed neuroblastoma. Fourteen days after the first operation, the adrenal tumor, right kidney and tumor thrombus remaining in the vena cava were removed to prevent the recurrence of right heart failure. Two courses of chemotherapy and radiation were given postoperatively and the patient was doing well. Eight months after the second operation, however, the patient died of multiple metastases of the bone and liver.     

Adrenal cortical carcinoma: preoperative demonstration of right atrial extension by sonography and computerized tomography

We report a case of adrenal cortical carcinoma with tumor thrombus extending to the right atrium. Tumor extension was demonstrated preoperatively with sonography and computerized tomography. We recommend that both modalities be used when evaluating masses in the suprarenal space. The preoperative diagnosis of tumor extension via the adrenal vein into the inferior vena cava was confirmed at operation.     

Suprarenal vena caval occlusion. Principles of operative management.

Retrohepatic occlusion of the inferior vena cava caused by tumor complicates complete resection and not infrequently is associated with life-threatening symptoms that accelerate the lethality of the underlying malignant process. This report summarizes our experience with caval thrombectomy and reconstruction that allowed complete removal of all gross tumor in seven patients with malignant occlusion of the retrohepatic inferior vena cava. Included in this group are five patients with renal cell carcinoma and extension of tumor into the retrohepatic vena cava. Three of these patients had extension of tumor thrombus into the right atrium. A sixth patient had recurrent right adrenal cortical carcinoma with tumor invasion of the vena cava and occlusion to the right atrium. Associated hepatic vein occlusion and secondary Budd-Chiari syndrome also was successfully managed in this patient. The final patient with occlusion of the entire suprarenal vena cava required caval reconstruction after resection of a primary leiomyosarcoma of the retrohepatic portion of the vena cava. Careful planning of the operative procedure, adequate exposure, complete mobilization of the retrohepatic vena cava, and control of the hepatic venous effluent will allow patients with retrohepatic vena caval occlusions to be managed with safety and success.     

Ectopic hepatocellular carcinoma in the adrenal gland with inferior vena cava thrombosis and right atrial extension

Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.     

Resection of atriocaval adrenal carcinoma using hypothermic circulatory arrest

Carcinoma of the adrenal cortex may occasionally extend through the inferior vena cava to the right atrium without actually invading the vascular endothelium. Surgical resection may result in excellent palliation and the potential for prolonged survival when no other signs of advanced disease are present. Extrapolating from our experience with renal cell carcinoma extending to the right atrium, we resected a similar adrenocortical carcinoma using hypothermic circulatory arrest.     

Malignant adrenocortical tumour with inferior vena cava invasion

Carcinoma of the adrenal cortex is a rare tumour. The incidence of vena cava involvement may be present in 15 to 20% of patients. The intra caval tumour thrombus can attain the right atrium. Even if some authors consider these lesions as a metastasis, long-term survival can be obtained after radical resection. The surgical tactical depend on the extension of thrombus into the vena cava inferior. The authors report a case with 4 years survival without recurrence after surgical treatment.     

Surgical repair of double-outlet right atrium

The case of a patient with abnormal position of the atrial septum resulting in a right atrium with two atrioventricular valves and a disconnected left atrium is presented. The left superior vena cava drained into the left atrium; the right superior vena cava and the coronary sinus were absent. The surgical technique for repair of this anomaly is described. A possible explanation of the embryopathogenesis of double-outlet right atrium is given. To our knowledge, this is the second case of double-outlet right atrium to be reported in the thoracic surgical literature.     

The triad of persistent left superior vena cava connected to the coronary sinus, right superior vena cava draining into the left atrium, and atrial septal defect: report of a successful operation for a rare anomaly

The triad of right superior vena cava connecting to the left atrium, persistent left superior vena cava draining into the right atrium (coronary sinus), and atrial septal defect is a rare malformation. Recently, we successfully corrected this anomaly in a 47-year-old man.     

Adrenocortical Carcinoma with Intracaval Extension to the Right Atrium: Resection on Cardiopulmonary Bypass

Case Presentation  

A 28-year-old woman presented with dyspnea on exertion and elevated testosterone level. A 21 × 19 cm right adrenal mass was found invading the liver and inferior vena cava (IVC); tumor thrombus extended to the right atrium on transthoracic echocardiogram.     

Partial resection of intravenous leiomyomatosis with cardiac extension

Intravenous leiomyomatosis with cardiac extension is rare and may result in a fatal outcome. A 58-year-old woman with a surgical history of myoma uteri was admitted to our hospital for treatment of intravenous leiomyomatosis extending into the right atrium through the inferior vena cava. We partially resected the tumor inside the right atrium and the inferior vena cava via the right atrium using cardiopulmonary bypass. There is no progression of the residual tumor after 25 months of follow-up.     

Transesophageal echocardiography in the surgical management of renal cell carcinoma with intracardiac extension.

Renal cell carcinomas may extend into the vena cava and the tumor thrombus occasionally involves the right atrium. The operative approach depends upon precise preoperative and intraoperative staging and thrombus localization. We report a case of renal cell carcinoma with complete inferior vena caval and hepatic vein occlusion with tumor extension into the right atrium. Preoperatively, transesophageal echocardiography provided superior images of the tumor and its extension, and intraoperatively allowed continuous monitoring of cardiac function and the removal of tumor from the atrium and inferior vena cava. Its use obviated the need for more costly and invasive preoperative and intraoperative procedures.     

腔静脉畸形的外科意义及手术治疗

本文报告先天性腔静脉畸形53例，双上腔静脉畸形，左上腔静脉引流入冠状静脉窦45例，对血流动力学无影响，术中仅4例作了插管引流，余仅在术中暂时阻闭了左上腔静脉，本文重点报道8例少见腔静脉畸形，包括右上腔静脉缺如（1例），左上腔静脉引流入右房顶（1例），引流入左房顶（2例），引流入冠状静脉窦并与左房交通（1例），下腔静脉引流入左房（1例，上腔和下腔静脉分别引流入左房（1例），以及全部体静脉分别引流入左房（1例），此8例的畸形矫治均较顺利，本文对少见腔静脉畸形的临床特征，诊断方法，手术矫治的要点和注意事项进行了较详细探讨。     

Mitral valve plasty in an adult patient without a right superior vena cava

Persistent left superior vena cava without a right superior vena cava is an extremely rare condition. We report the case of a 65-year-old woman with this condition who underwent mitral valve plasty. During cardiac catheterization, the asymptomatic patient with mitral valve prolapse syndrome was found to have a persistent left superior vena cava without a right superior vena cava. During mitral valve plasty, cardiopulmonary bypass was established using bicaval drainage through the persistent left superior vena cava and the right atrium. A cannula was inserted into the persistent left superior vena cava to provide a large surgical field in the left atrium. We selected a technique that involved direct insertion of an L-shaped cannula into the persistent left superior vena cava and obtained a clear view of the surgical field. Proper assessment of the right superior vena cava is necessary when a persistent left superior vena cava is suspected.     

The removal of renal carcinoma thrombus extending to the right atrium by means of extracorporeal circulation: report of a case]

A case of renal cell carcinoma with a tumor thrombus extending to the right atrium was reported. A 70-year-old woman was admitted with a diagnosis of right renal tumor which had been detected on a routine abdominal ultrasonography. MRI revealed a tumor thrombus extending into the right atrium through the inferior vena cava. A transesophageal echocardiogram confirmed that the tumor extended into the right atrium, and was not adherent to the inferior vena cava and the atrium. Right nephrectomy and removal of the tumor thrombus were performed using extracorporeal circulation. Temporary occlusion of portal venous and hepatic arterial inflow was effective in reducing blood loss. She has been doing well, and there has been no evidence of recurrence during 18 month postoperatively.     

Resection of advanced stage malignant retroperitoneal neoplasms with tumor thrombus extending into the right atrium: Report of four cases

Surgery for retroperitoneal neoplasms with a tumor thrombus extension into the right atrium is challenging. This study reviewed four surgical cases of advanced stage malignant neoplasms with the tumor thrombus extending into the right atrium. The malignant neoplasms involved the kidney in two patients, and the liver and adrenal gland in one each. The tumor thrombus was removed through a longitudinal cavotomy and right atriotomy in all cases. The inferior vena cava reconstruction was performed by directly closing it in one patient and by pericardial patch suturing in another. Cardiopulmonary bypass was used for all procedures and a Pringle maneuver was used to reduce bleeding from the liver in three. There was no perioperative or hospital death. Two of the four with renal cell carcinoma were alive 7 and 13 months after the surgery. One with hepatocellular carcinoma died of recurrent malignancy after 4 months, while the patient with an adrenal carcinoma remained disease free after surgery. These cases indicate the safety of the present procedure. Although the long-term results are still unknown, there were favorable early results and a lack of perioperative complications. Surgical challenges in resecting an intracardiac extension of retroperitoneal malignancy require close cooperation among the attending urologist, and both gastrointestinal and cardiovascular surgeons.     

Scimitar syndrome with an accessory diaphragm and an absent right superior vena cava

An 8-year-old boy with scimitar syndrome, an accessory diaphragm and an absent right superior vena cava, underwent surgery on March 28, 1983. The scimitar vein was separated from an accessory diaphragm and cut just above the right diaphragm where the vein penetrated. The vein was re-implanted into the right lateral portion of the right atrium and a tunnel was made between the atrial septal defect created in the septum and the site of the implanted vein. The accessory diaphragm was not removed because of the lack of compression on the right lung. At cardiopulmonary bypass, venous cannulae were inserted into the persistent left superior vena cava and inferior vena cava. Because of the absence of the right superior vena cava, the right atrium was not fixed by both cavae so that there was difficulty in intracardiac maneuvers. The patient is doing well 32 months after this treatment.     

下腔静脉膈上段解剖特征及毗邻关系的尸体研究

目的:明确腹腔镜手术中下腔静脉膈上段的解剖特点及毗邻关系。方法:2018年12月于南方医科大学基础医学院选取成人尸体、新鲜尸体各2例。对冰冻尸体进行解剖。沿双侧锁骨中线打开胸腔,翻开心包前壁,解剖分离上腔静脉、下腔静脉。沿腹正中线打开腹腔,翻左、右肝叶,显露肝后段下腔静脉、第二肝门,剖开腔静脉裂孔进入心包,观察下腔静脉...     

Intravenous leiomyomatosis of the uterus with extension into the heart

A case was reported concerning a successful removal of a leiomyoma with extension into the right atrium through the right ovarian vein and the inferior vena cava. The patient was a 72 year-old woman who had suddenly suffered dyspnea and palpitation. She was hospitalized, and a mass in the right atrium and the inferior vena cava was discovered using echocardiography and magnetic resonance imaging. A myxoma in the right atrium with a thrombus in the inferior vena cava was diagnosed preoperatively. The operation was performed in July 1987 by means of cardio-pulmonary bypass. During atriotomy of the right atrium, a large sausage-shaped mass of milky-pinkish color was found. Though the root of the mass was centered beyond the periphery of the inferior vena cava, most of it was removed through the right atrium. Immediately after extirpation of the tumor, hypotension and abdominal distention occurred in the patient, and emergency laparotomy was carried out. Retroperitoneal bleeding from the right ovarian vein occurred and the similar tumors were observed in the right ovarian vein. Intravenous leiomyomatosis of the uterus with extension into the heart is very rare, this being only the seventeenth case reported in literature. To the best of our knowledge, this was also the oldest patient on record. The good surgical method for this tumor seems to be total removal using cardio-pulmonary bypass and laparotomy at the same time.     

Scimitar syndrome with an accessory diaphragm and an absent right superior vena cava

An 8-year-old boy with scimitar syndrome, an accessory diaphragm and an absent right superior vena cava, underwent surgery on March 28, 1983. The scimitar vein was separated from an accessory diaphragm and cut just above the right diaphragm where the vein penetrated. The vein was re-implanted into the right lateral portion of the right atrium and a tunnel was made between the atrial septal defect created in the septum and the site of the implanted vein. The accessory diaphragm was not removed because of the lack of compression on the right lung. At cardiopulmonary bypass, venous cannulae were inserted into the persistent left superior vena cava and inferior vena cava. Because of the absence of the right superior vena cava, the right atrium was not fixed by both cavae so that there was difficulty in intracardiac maneuvers. The patient is doing well 32 months after this treatment.     

Extension incision for renal carcinoma including invaded vena cava and right lobe of liver.

We report on a thirty-five-year-old woman with renal cell carcinoma who successfully underwent right radical nephrectomy and extended right hepatic lobectomy with resection and reconstruction of inferior vena cava (IVC). A temporary bypass was placed between the infrarenal IVC and right atrium using a heparin-coated synthetic tube. The tumor was resected en bloc including right kidney, adrenal gland, hepatic lobe, and IVC. The IVC was reconstructed using an expanded polytetrafluoroethylene (EPTFE) graft. Her postoperative course was uneventful with no signs of recurrence four years after surgery.