Child ; Humans ; Kidney Neoplasms ; complications ; surgery ; Male ; Thrombectomy ; methods ; Vena Cava Filters ; Vena Cava, Inferior ; pathology ; Wilms Tumor ; complications ; surgery

Inferior vena caval (IVC) tumor thrombus, majorly originated from intravenous leiomyomatosis (IVL) and renal or hepatic carcinoma, can extend into right cardiac cavities. Complete tumor resection, supported by cardiopulmonary bypass (CPB), has been proved to be the most effective treatment but also to be dramatically challenging. Randomized clinical trials of the surgical treatment for IVC tumor with cardiac extension are very limited due to the disease rarity, whereas publications on IVC tumor surgery are predominately confined to case report. So far, no clinical research or review, focused on intraoperative anesthesia management for surgical resection of IVC tumor with cardiac extension, has been identified; even anesthesia-targeted case report can not be found. In this article, we briefly introduce the disease characteristic and related surgical procedure and offer some suggestions upon the anesthesia management based on our own clinical experiences.
Anesthesia ; Heart Neoplasms ; secondary ; Humans ; Kidney Neoplasms ; pathology ; Liver Neoplasms ; pathology ; Thrombosis ; pathology ; Vena Cava, Inferior

One case with ascites and lower limb edema as the initial manifestations was reported.The echocardiography revealed inferior vena cava and right atrial occupation,which combined with increased alpha fetoprotein and imaging examination,suggested liver malignant tumor combined with tumor thrombus of inferior vena cava and right atrium.After targeted therapy combined with immunotherapy,the tumor shrank and alpha fetoprotein decreased significantly,suggesting that the treatment was effective.The median survival time of the patient was 3 months.This patient had a clear history of cirrhosis due to hepatitis B and was clinically diagnosed with advanced liver cancer,which suggested the importance of early liver cancer screening.
Humans ; Vena Cava, Inferior/pathology* ; alpha-Fetoproteins ; Echocardiography ; Heart Atria/pathology* ; Liver Neoplasms/pathology*

The etiology and pathology of Budd-Chiari syndrome (BCS) remain unclear. The membrane in some membranous BCS may be derived from the absorption and organization of the thrombus of inferior vena cava (IVC). The long-term efficacies of currently available graft shunt operations are unsatisfactory. Interventional therapy or radical resection of lesion should be recommended. The IVC stenosis actually results from the compression of hepatomegaly and should not be classified as BCS. The membranous BCS is an acquired disease.
Budd-Chiari Syndrome ; diagnosis ; etiology ; pathology ; surgery ; China ; Humans ; Vena Cava, Inferior ; pathology

Conventional radiology of the pancreas are too often unsatisfactory. It is well known that the whole body CTis very useful in identifying retroperitoneal pathology. The authors intended to present normal pancreaticmorphology and data for preparation of basis for interpretation o abnormalities. We results were as follows; 1.There were 36 male and 24 female patients, and their ages ranged fro 7 to 78 years. 2. 1) The organs adjacentpancreas were stomach, inferior vena cava, duodenum, caudate lobe of the liver left kidney, left adrenal gland,superior mesenteric vessels, spleen. 2) In 19 patients, pancreatic tail at the level of left kidney in thetransverse plane, it was either ventral in 13(68%), ventromedial in 2(19%), ventrolateral in 4(21%) to leftkidney, in the other ventral in 13(68%), ventromedial in 2(19%), ventrolateral in 4(21%) ot left kidney, in theother 41 patients, it was cranial to the upper pole of left kidney, ventral in 15(61%), ventromedial in 1(2%),ventrolateral in 15(37%). 3) Pancreatic tail was cranial to the pancreatic body, 3cm cranial in 2(4%), 2-3cm in5(8%), 1-2cm in 6(10%), less than 1cm in 11(18%). In the other, caudal in 3(5%). 3. Pancreatic shape was uniformtapering form in 37(62%), lobulated form in 23(38%). 4. Pancreatic orientation was horizontal in 13(22%), vertical56(76%), S-shaped in 1(2%). 5. Pancreatic margin was smooth in 22(37%), lobulated in 38(63%). 6. In most patients,pancrease was uniform in density. 7. Pancreatic size was 0.5+-0.1 in measurement ratio of the head in 48(80%),0.4+-0.1 of the body in 49(88%), 0.5+-0.1 of the tail in 47(78%).
Clothing ; Duodenum ; Female ; Head ; Humans ; Kidney ; Liver ; Male ; Pancreas ; Pathology ; Spleen ; Stomach ; Tail ; Vena Cava, Inferior

OBJECTIVETo investigate clinicopathological features, immunophenotype and differential diagnosis of intravenous leiomyomatosis with intracardiac extension.

METHODSClinical manifestations, morphologic features, and immunohistochemical staining were retrospectively analyzed in 19 cases of intravenous leiomyomatosis with intracardiac extension.

RESULTSThe patients' age ranged from 33 to 59 years (mean 44 years). Clinical presentation included chest tightness, palpitation, dyspnea, edema of low extremity, abdominal distention or hypermenorrhea. However, a few patients were asymptomatic. Grossly, intravenous leiomyomatosis in most cases demonstrated coiled or nodular growth within the myometrium with worm-like involvement of the uterine vein in broad ligament or other pelvic veins with continued extension into the vena cava and the heart. The intravenous tumor surface was generally smooth and rubbery, with a greyish-white color. Microscopically, the tumors were composed of spindle cells with rare mitotic figures and the presence of abundant thick-walled vessels. Marked fibrosis, hyalinization, myxoid and edematous changes were common. The tumor cells were positive for SMA, ER, PR and desmin but negative for HMB45 and S-100. CD10 and CD34 were positive in 4 patients and negative in the remaining cases.

CONCLUSIONIntravenous leiomyomatosis with intracardiac extension is a rare disease among women of child-bearing age, with specific morphologic manifestations and immunohistochemical profiles.

Adult ; Diagnosis, Differential ; Female ; Humans ; Leiomyomatosis ; diagnosis ; pathology ; Middle Aged ; Retrospective Studies ; Uterus ; pathology ; Vena Cava, Inferior ; pathology

BACKGROUNDBudd-Chiari syndrome (BCS) is a rare disease with portal hypertension caused by the blockage of the hepatic vein and/or the inferior vena cava (IVC). Angiography is the "golden standard" for diagnosis, but it is an invasive examination. To assess the diagnostic value of a fresh blood imaging (FBI) relative to BCS, we used a magnetic resonance angiography (MRA) with an FBI sequence for a preoperative evaluation of the BCS patients in this study.

METHODSFifty patients who were suspected of having BCS after they had been checked by a B-ultrasound were studied. 2D and 3D FBI were performed on a 1.5T superconductive MR scanner. Original images were rebuilt using a maximal intensity projection (MIP) method on the console. Two doctors reviewed all images before they learned of the angiography results. We then compared the diagnoses obtained from the FBI and angiography results to evaluate the diagnostic value of the FBI.

RESULTSForty-one patients were diagnosed as BCS and 9 as non-BCS based on an angiography. The FBI correctly diagnosed 38 patients, incorrectly diagnosed 1 patient, and missed diagnosis in 3 patients. Thus, the diagnostic sensitivity of the FBI is 93% (38/41), the specificity is 89% (8/9) and the accuracy is 92% (46/50). The FBI images of the 13 membranous stenoses of the IVC showed a sudden stenosis of the post-liver segment of the IVC. The Images of the 5 patients with a membranous obstruction of the IVC showed IVC thickening and an absence of blood signals in the post-hepatic segment of the IVC. The images of the 4 patients with the segmental thrombosis of the IVC showed abnormal and intermittent signals in the IVC. The images of the 6 patients with a simple hepatic vein obstruction showed obstructive hepatic veins. The images of the 6 patients with the stenosis of both the IVC and the hepatic veins showed the stenosis of the IVC, the thickening of the hepatic veins and the formation of a compensatory circulation within the liver. Lastly, the images of the 7 patients showed a combination of the IVC thrombosis with stenosis or with the obstruction of one or two hepatic veins.

CONCLUSIONSAn FBI can show a membranous stenosis, and an obstruction and thrombosis of the IVC. In addition, it can also demonstrate the thickening of the flexural hepatic vein and the development of intra-hepatic compensatory branches with slow blood flow. Thus, it can guide the puncturing and opening of the hepatic vein involved in an interventional therapy for BCS patients.

Aged ; Budd-Chiari Syndrome ; diagnosis ; pathology ; Female ; Humans ; Magnetic Resonance Angiography ; methods ; Male ; Vena Cava, Inferior ; pathology

OBJECTIVETo clarify the proper surgical procedure of treating hepatocellular carcinoma (HCC) with a tumor thrombus in the inferior vena cava (IVC).

METHODSFour patients with HCC with a tumor thrombus in the IVC underwent hepatectomy and thrombectomy. Following hepatectomy, tumor thrombus was removed by incising the wall of the IVC in 3 patients and from the hepatic vein in one patient. The 3 patients underwent thrombectomy under either hepatic vascular exclusion (HVE) or Satinsky's vascular clamping.

RESULTSAll the operations were successful without operative death and major complications. The postoperative course was uneventful in 3 patients and pleural effusion occurred in one patient who needed thoracentesis. Follow-up showed 3 patients died after 30, 10 and 14 months, respectively, and one patient is alive for 7 months.

CONCLUSIONSHCC with tumor thrombus in the IVC is operable and the proper procedure is hepatectomy plus thrombectomy.

Carcinoma, Hepatocellular ; complications ; surgery ; Humans ; Liver Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Vena Cava, Inferior ; pathology

Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement.
Child, Preschool ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal/*diagnosis/pathology/ultrasonography ; Renal Veins/pathology/*radiography ; Thrombosis/pathology/radiography ; *Tomography, X-Ray Computed ; Vena Cava, Inferior/pathology/*radiography

Carcinoma, Renal Cell ; immunology ; pathology ; surgery ; Humans ; Keratin-19 ; metabolism ; Kidney Neoplasms ; immunology ; pathology ; surgery ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; pathology ; Nephrectomy ; Vena Cava, Inferior ; pathology ; surgery