Renal cell carcinoma extending into vena cava and right atrium

We report on a patient who underwent complete removal of a renal cell carcinoma extending into the vena cava and the right atrium. A review of the literature confirms the rarity of vena caval obstructive symptoms. Emphasis is on preoperative diagnosis, thoracoabdominal exposure, and team approach. Survival rates warrant aggressive surgical treatment in these patients.     

Large adrenocortical carcinoma extending into the inferior vena cava and right atrium

A case of large adrenocortical carcinoma extending into the inferior vena cava and right atrium is reported. Computed tomography showed a large mass displacing the left kidney inferiorly with an intravascular tumour thrombus extending into the inferior vena cava and right atrium. Radical surgery under hypothermia and cardiopulmonary bypass was performed and the tumour mass, together with the tumour thrombus, was successfully removed. The presence of intravascular tumour extension alone should not be a contraindication to radical surgical therapy, as it is the best hope for prolonged survival.     

Surgical approach to renal cell carcinoma extending into the right atrium through the inferior vena cava

Successful management of a patient with an intracardiac tumor thrombus of renal carcinoma is described. This case and a few others in the literature have led us to consider the clinical signs of cavo-atrial obstruction, frequently silent and unspecific; the diagnostic methodology, especially based upon CAT scan and cavography, and the type of surgery and surgical technique called for, especially as regards the approach and the possible use of extracorporeal circulation (ECC).     

Adrenocortical carcinoma extending into the inferior vena cava in a patient with right kidney agenesis: Surgical approach and review of literature

INTRODUCTIONAdrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis and the association with tumor thrombus into the inferior vena cava (IVC) is not common. The best treatment is represented by radical surgery.PRESENTATION OF CASEWe describe a case of a large ACC of the left adrenal gland extending into the IVC through the left renal vein in a young patient with agenesis of the right kidney and signs of acute renal failure. A midline laparotomy was performed, subsequently extended by a left thoracophrenotomy through the 7th intercostal space in order to control the proximal surface of the mass and the thoracic aorta. The tumor was completely excised preserving the kidney, and thrombectomy was performed by a cavotomy with a temporary caval clamping, without cardiopulmonary by-pass (CPB).DISCUSSIONWe discuss surgical approaches reported in literature in case of ACC with intracaval extension. The tumor must be completely resected and the thrombectomy can be performed by different approaches: cavotomy with direct suture, partial resection of caval wall without reconstruction, resection of vena cava with graft reconstruction. These procedures could require a CPB, with an increased mortality. In our case we preserved the kidney and a thrombectomy without CPB was performed.CONCLUSIONIntracaval extension of ACC does not represent a contraindication to surgery. The best treatment of intracaval thrombus should be the cavotomy with direct suture. The CPB is not always required. In presence of renal agenesis, the preservation of the kidney is mandatory.     

Successful resection of cardiac metastatic liposarcoma extending into the SVC, right atrium, and right ventricle

Cardiac metastatic liposarcoma is a rare tumor. We report a case of successful resection of a cardiac metastatic liposarcoma extending into the superior vena cava (SVC), right atrium, and right ventricle. Using cardiopulmonary bypass (CPB) by venous cannulation of the upper portion of the SVC and inferior vena cava (IVC), the intracardiac tumor was completely resected. Surgical resection with the addition of radiotherapy prolonged the patient's life.     

Left main coronary artery fistula to the right atrium and superior vena cava: case report and review of the literature

A unique arteriovenous fistula, originating from the left main coronary artery and branching to drain into the right atrium and superior vena cava is presented with review of the literature.     

Thoracoabdominal-median sternotomy for resection of primary adrenal carcinoma extending into inferior vena cava and hepatic vein

A technique utilizing a combined thoracoabdominal-median sternotomy approach is described for simultaneous resection of a large adrenal cancer occluding the inferior vena cava and extending into the left hepatic vein. This technique is useful in removing an extensive extension of a renal or adrenal cancer into the inferior vena cava.     

Renal cell carcinoma extending into the right atrium; report of a case

A 62-year-old male was diagnosed through abdominal ultrasonography, with right renal cell carcinoma extending into the inferior vena cava. Surgery was performed because echocardiography revealed the tumor to have reached the right atrium. The portion of the tumor situated in the right atrium was resected under the extracorporeal circulation. Distal part of inferior vena cava was resected with the tumor included. The tumor remaining in the confluence of hepatic veins was removed from the incised end of the inferior vena cava and was detached from the venous wall. Postoperative abdominal echography revealed a small additional tumor mass in hepatic veins. Although this mass was considered to be a remnant of the intravenous tumor, an additional surgical procedure was judged to be impossible. In retrospect, an additional long-axis incision on the inferior vena cava might have enabled us to catch the remnant of the tumor thrombus in the hepatic vein.     

Testicular carcinoma with inferior vena cava thrombosis extending into the right atrium treated with chemotherapy and anticoagulation.

A 34-year-old male with pulmonary emboli and thrombosis of the inferior vena cava extending into the right atrium was found at presentation to have a mixed seminoma and embryonal cell testicular carcinoma with high-volume retroperitoneal disease and visceral metastases. The patient was free of disease 19 months after treatment with combination chemotherapy and anticoagulation followed by resection of the residual mass. We could not find any previous report of a patient with bulky retroperitoneal disease and vena cava thrombosis successfully treated with chemotherapy without vena cava resection.     

Removal of renal cell carcinoma extending into the right atrium: report of a case]

A 65-year old man presented with a seven-month history of macrohematuria and left back pain. Abdominal ultrasonography, enhanced computed tomographic (CT) scanning, magnetic resonance imaging (MRI), selective renal angiography and vena cavography revealed a left renal tumor extending into the inferior vena cava and right atrium. Surgery was performed using the cardiopulmonary bypass and the whole tumor was resected grossly except for the tumor invading into the lumbar vein. The patient recovered promptly but died from cancer metastasis six months after operation.     

A case of intravenous leiomyomatosis of uterine origin, extending through the inferior vena cava to right atrium

Intravenous leiomyomatosis (IVL) is a rare benign tumor that originates from uterus, and sometimes extends to the right heart. We report a case of IVL that extended to right atrium through the inferior vena cava (IVC) which was resected using partial cardiopulmonary bypass. Multi detector computed tomography and ultrasound played a vital role in arriving at the diagnosis. Complete resection of tumor in the heart and great vein, and separation of the tumor stump from the IVC are essential in the treatment of IVL.     

Adrenocortical carcinoma extending into the inferior vena cava: presentation of a 15-patient series and review of the literature

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.     

A case report of left renal cell carcinoma with tumor thrombus extending into the right atrium

A case report of left renal cell carcinoma with tumor thrombus extending into the right atrium is reported. A 76-year-old woman was found to have a left renal tumor with tumor thrombus extending into the inferior vena cava and right atrium by computed tomographic-scanning. Left nephrectomy and removal of an intra-atrial tumor thrombus were performed under a cardiopulmonary bypass. The post-operative course was uneventful and the patient was discharged from the hospital 22 days postoperatively. The pathological diagnosis was clear cell carcinoma. After surgery, the patient received interferon-gamma. However, the patient developed lung metastases 26 months after the operation and is currently being observed while receiving interferon-alpha.     

Surgical management of renal carcinoma with extensive involvement of the vena cava and right atrium.

Between 1988 and 1990, 8 patients with a renal tumour extending into the vena cava and with supradiaphragmatic extension were treated by an operative technique involving extracorporeal circulation and deep hypothermic circulatory arrest. In 4 patients the thrombus extended into the right atrium. Six patients appeared to have a renal carcinoma. Intra-operatively one patient's tumour proved to be a metastasis of a squamous cell carcinoma of the lung and another patient was found post-operatively to have a leiomyosarcoma of the vena cava. Two of these 6 patients died from metastases 6 weeks and 8 months post-operatively. Four patients are symptom-free, although 3 of them have liver or lung metastases 10, 20 and 37 months post-operatively. One has no evidence of disease 18 months post-operatively. The use of extracorporeal circulation and deep hypothermic circulatory arrest provides optimal surgical exposure and gives the patients a considerable complaint-free interval post-operatively. How often cure is also achieved is as yet unclear.     

Spontaneous rupture of the inferior vena cava: case report and literature review

Spontaneous rupture of the inferior vena cava is a rare clinical entity. Diagnosis of this condition, in the absence of any relevant history, is usually made at laparotomy. Only one such case has previously been reported in the literature. We report a case of spontaneous rupture of the inferior vena cava which was diagnosed following laparotomy for hypovolaemia and acute abdominal pain. This case highlights the fact that spontaneous rupture of the inferior vena cava may be a cause of massive intra-abdominal bleeding not associated with trauma or rupture of the abdominal aorta.     

Tumor thrombectomy for endometrial stromal sarcoma extending into the inferior vena cava and the right atrium from the uterus

We report an extremely rare case of endometrial stromal sarcoma (ESS) extending into the inferior vena cava and the right atrium. A 65-year-old woman was admitted to our hospital due to lower-extremity edema. The chest-abdominal computed tomography (CT) showed tumor thrombus invading the inferior vena cava and right atrium with multiple lung metastasis. To prevent sudden death from pulmonary embolism, she underwent surgical removal the tumor thrombus with the use of cardiopulmonary bypass and deep hypothermic circulatory arrest. The pathological diagnosis of the tumor thrombus was low-grade ESS originating from the uterus. After thrombectomy, she underwent chemotherapy with carboplatin and paclitaxel. Surgical resection and chemotherapy to low-grade ESS achieved favourable prognosis.     

肥胖患者侧卧位微创经皮肾镜取石术导丝误入右心房及肾造瘘管误入腔静脉一例报告并文献复习

目的 探讨肥胖患者行B超引导下侧卧位微创经皮肾镜取石术(mininimally invasive percutaneous nephrolithotomy,MPCNL)中肾静脉损伤导致造瘘管置入腔静脉、导丝进入右心房的处理方法. 方法 回顾性分析2014年5月收治的1例左输尿管结石左肾积水男性患者的临床资料.年龄30岁.因反复左侧腰部疼痛5年,检查发现左肾结石伴左肾积水入院.患者有大量饮酒史3年,高血压病、糖尿病史6个月.体质指数35.9 kg/m2.查体:血压150/110 mmHg(1 mmHg=0.133 kPa).左肾区叩痛明显.B超检查:左侧肾盂输尿管连接处见约1.5 cm×1.0 cm强光团,后伴声影,左肾中度积水.CT检查:左侧输尿管上段结石伴左肾中度积水,增强扫描左肾皮质CT值100 HU.全麻下行B超引导下侧卧位MPCNL.术中建立经皮肾通道时因出血导致视野不清,留置斑马导丝及肾造瘘管准备二期行MPCNL. 结果 术后第7天复查CT发现导丝位于右心房,肾造瘘管位于腔静脉内达肝门水平.在CT引导下拔出导丝,每次约10 cm,观察5 min,患者无不良反应则再拔出10 cm,共5次将斑马导丝退入肾造瘘管内,将肾造瘘管退至肾分支静脉内距肾盂1 cm处停止,待分支肾静脉穿刺口血栓形成和愈合.术后第9天再次在CT监视下将肾造瘘管退入肾盂内,引流出清亮黄色尿液.术后第14天在全麻下经原通道行MPCNL,于肾盂输尿管连接处寻及约1.5 cm×1.0 cm结石,在输尿管镜下行气压弹道碎石术,检查各肾盏及输尿管上段无残石后,留置双J管及肾造瘘管,术中及术后无血尿,患者无不适.二次手术后3d拔除肾造瘘管.二次手术后1个月拔除双J管,患者无特殊不适. 结论 肥胖患者行B超引导下侧卧位MPCNL时经皮肾通道建立难度大,术中穿刺深度与术前CT检查测量的距离存在误差,易导致损伤.术中肾静脉损伤及肾造瘘管误入腔静脉时,可以通过夹闭造瘘管进行止血.在充分做好抢救准备的前提下,可在CT引导下分次逐步拔除导丝及造瘘管.