Metastatic renal cell carcinoma invading liver, duodenum and ivc, surgical treatment and literature review. A case report

Renal Cell Carcinoma has a biologic predisposition for direct vascular invasion: intravascular tumor thrombus is found in 5% to 20% of the cases inside the renal vein or the inferior vena cava. Despite new and effective conservative therapy such as targeted therapy and immunotherapy, cytoreductive nephrectomy and palliative nephrectomy continues to have an important role in T4 patient. The patient selection for cytoreductive nephrectomy should be done carefully. This report present an unique case of metastatic RCC with invasion of the duodenum, liver and retrohepatic IVC, the adopted surgical approach and a review of the literature. Complete surgical extirpation is possible in cases of RCC invading other organs such as pancreas, duodenum, liver, retroperitoneum and IVC. In this scenario, to narrow the possible intraoperative complication, a multidisciplinary approach and equipe is recommended

Emergency surgery for retrograde extension of type B dissection after endovascular stent graft repair

Endovascular stent graft repair of type B dissection is a new and alternative treatment to the surgical or medical therapy. This technique is not free from minor or major complications and we herein report the case of a patient who developed a retrograde dissection after endovascular stent graft placement. The emergent surgical treatment undertaken consisted of ascending aorta replacement without treating the arch in account of the presence of the endoluminal prosthesis. (C) 2001 Published by Elsevier Science B.V

Successful resection of thymoma directly invading the right atrium under cardiopulmonary bypass

We present the case of an invasive thymoma with severe compression of the right atrium, and infiltration of the atrial wall, causing a superior vena cava (SVC) syndrome. The tumour was resected under cardiopulmonary bypass en bloc with the atrial wall. A bovine pericardial patch was used for atrial reconstruction. We obtained a complete resection of the tumour and regression of symptoms, and, after 1 year of the follow-up, no signs of recurrence are evident. To our knowledge, this is the first case of thymoma directly invading the right atrium, without involvement of the SVC. In this setting, the aggressive surgical approach led to an immediate resolution of the symptoms and contributed to prolonged long-term survival

Extended operations for recurrent thymic carcinoma presenting with intracaval growth and intracardiac extension

Thymic carcinoma is a relatively uncommon tumor that represents less than 1% of thymic malignancies. The prognosis is often poor, with a 5-year survival for all patients of between 31% and 50%.1 At present, a multimodality approach including aggressive surgical resection, platinum-based combination chemotherapy, and radiotherapy seems the preferred therapeutic strategy. Overall recurrence rate is very high and vascular invasion is particularly associated with poor prognosis. [2] and [3] Only aggressive and complete resection yields long-term survival. We report the management of recurrent thymic carcinoma with extension into the right atrium, resulting from the progression of intracaval growth, 4 years after induction chemotherapy and successful total resection followed by chemoradiation treatment

Endoluminal stent-grafting of the descending thoracic aorta

The timing and optimal therapy for descending thoracic aortic diseases still remain a challenging problem for surgeons. Nowadays endovascular treatment is becoming more and more popular both for acute as well as chronic cases. This technique is more respectful of the tissue integrity and avoids major and demolitive surgery for the patient. METHODS: In 1 year 32 patients presenting with descending thoracic aorta dissection (n = 25) or with descending thoracic aorta aneurysms (n = 7) were submitted to an endovascular procedure using covered stents. Ten of them were operated upon in general anesthesia whereas in 22 spinal anesthesia was administered. In neither group did anesthesia-related complications occur. RESULTS: In all cases in which endovascular treatment was possible, an endovascular stent was used for the treatment of the descending thoracic aorta disease. Only 1 patient had a major complication, which was a retrograde dissection of the ascending aorta surgically treated in an emergency setting. Our policy is to treat uncomplicated type B dissections in the subacute phase after 1 week of antihypertensive pharmacological treatment, but within 1 month of onset. Our mid-term follow-up shows very good results with no mortality and no stent-related complications. CONCLUSIONS: Stent grafting is replacing conventional surgery for descending thoracic aorta aneurysms and dissections. Our results suggest that in case of dissections, endovascular treatment should be delayed until the subacute phase, in the absence of complications. The risks and mortality are decreased

Primary leiomyosarcoma of the innominate vein

Primary Leiomyosarcoma of the Innominate Vein Giulio Illuminati, MD, Fabio Miraldi, MD, Giuseppe Mazzesi, MD, Antonio D’urso, MD, Gianluca Ceccanei, MD, and Marcello Bezzi, MD, Rome, Italy Primary venous leiomyosarcoma is rare. We report the case of a primary leiomyosarcoma of the left innominate vein, with neoplastic thrombus extending into the left jugular and subclavian veins. The tumor was curatively resected en bloc with anterior mediastinal and laterocervical lymphatics, through a median sternotomy prolonged into left cervicotomy. Primary venous sarcomas may be associated with prolonged survival in individual cases, with curative resection recommended as the standard treatment, in the absence of distant spread. Primary venous leiomyosarcoma is rare and affects most commonly the inferior vena cava, whereas, sporadically, other primary venous localizations have been reported, including ovarian, iliac, and greater saphenous veins.1 It is usually considered a lethal disease;1 nevertheless, long-term survival after curative surgery can be achieved.2 The rare observation of a primary leiomyosarcoma of the left innominateeinternal jugular vein, without distant spread at the time of diagnosis, treated with radical surgical resection, is reported herein