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

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

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

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

OBJECTIVETo review the experience for the management of hepatocellular carcinoma with tumor thrombus in inferior vena cava.

METHODSFrom July 2003 to May 2005, hepatectomy combined with thrombectomy were performed on 7 cases of hepatocellular carcinoma with tumor thrombus in inferior vena cava. In order to remove the tumor thrombus in inferior vena cava, total hepatic vascular exclusion were adopted on all cases to control the blood flow of IVC. According to the position of extension of tumor thrombus, 5 different procedures were adopted in the cases to control the suprahepatic IVC and extract the tumor thrombus out of IVC and atrium. Procedure 1: Median sternotomy, extracorporeal bypass, cardiac arrest, incision on right atrium and IVC were performed on 1 case for thrombectomy. Procedure 2: Median sternotomy, extracorporeal bypass without cardiac arrest, incision on IVC and (or without) incision on right atrium were performed on 2 cases for thrombectomy. Procedure 3: Abdominal approach to control intrapericardial IVC through an incision on diaphragm was performed on 1 case for thrombectomy. Procedure 4: Abdominal approach to control suprahepatic IVC above diaphragm through a small incision made on vena cava foramen for thrombectomy was performed on 1 case. Procedure 5: Abdominal approaches to control suprahepatic IVC below diaphragm for thrombectomy were performed on 2 cases.

RESULTSAll operations were successfully performed. The postoperative complications included pleural effusion in 1 case, subphrenic fluid collection in 1 case and wound infection in 1 case. The average survival time of 7 cases was 9.8 month. The longest survival time was 26 months.

CONCLUSIONHepatectomy and thrombectomy can be safely performed on the case of HCC combined with tumor thrombus in IVC. Surgical treatment can relieve the patient from the risk of sudden death caused by heart failure and pulmonary.

Adult ; Aged ; Carcinoma, Hepatocellular ; pathology ; surgery ; Embolectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Vena Cava, Inferior ; pathology

Renal angiomyolipoma (AML) with renal vein, inferior vena cava (IVC), and right atrial embolism is a rare solid tumor, whose etiology and pathogenesis are still unclear. Moreover, it is often misdiagnosed. One patient with renal AML complicated with renal vein, IVC, and right atrial embolism was admitted to the Second Xiangya Hospital of Central South University, who was a 35-year-old female, without any previous medical history, presented with right low back pain for more than 3 years. Computed tomography (CT) scan showed irregular lobulated fatty density mass in the right kidney, renal vein, IVC, and right atrium. The contrast-enhanced scan showed no enhancement of fat components at each phase and mild enhancement of solid components. Radical resection of the right kidney and removal of tumor thrombus were performed, and there was no recurrence 1 year after the operation. It is rare for renal AML to grow along the renal vein, IVC, and extend to the right atrium. Imaging examination is extremely important, and the CT findings of this case are characteristic, but the diagnosis eventually depends on pathological and immunohistochemical examinations.
Female ; Humans ; Adult ; Vena Cava, Inferior/pathology* ; Angiomyolipoma/surgery* ; Atrial Fibrillation ; Kidney Neoplasms/surgery* ; Embolism/pathology* ; Heart Atria/diagnostic imaging* ; Leukemia, Myeloid, Acute/pathology*

BACKGROUNDAn important characteristic of renal cell carcinomas and adrenal tumors is that these tumors may expand into the renal vein and inferior vena cava, and transform into tumor thrombi. This study was to evaluate the use of piggyback liver transplant techniques for surgical management of urological tumors with inferior vena cava tumor thrombus.

METHODSNineteen patients with renal cell carcinomas or adrenal tumors with inferior vena cava tumor thrombus were treated from November 1995 to April 2008. Their ages ranged from 29 years to 76 years (mean 54 years). The extent of tumor thrombus was infrahepatic (level I) in 2, retrohepatic (level II) in 7, suprahepatic (level III) in 6, and intra-atrial (level IV) in 4 patients. We used cardiopulmonary bypass with deep hypothermic circulatory arrest to remove the thrombi in 3 cases of level IV and in 2 cases of level III. In all level II, 4 level III, and 2 level IV cases, we used piggyback liver transplant techniques to mobilize the liver off of the inferior vena cava and to separate the inferior vena cava from the posterior abdominal wall.

RESULTSMean operative time was 5.1 hours, mean estimated blood loss was 2289 ml and mean blood transfusion was 12.84 U. One patient with adrenal cortical carcinoma and level IV thrombus died in the immediate postoperative period. Three patients were lost to follow up, and the other 15 survivors were followed from 5 months to 56 months. Eight of these 15 patients died due to metastasis; however 7 were still alive at the last follow-up.

CONCLUSIONSAn aggressive surgical approach is the only hope for curing patients diagnosed with urological tumors combined with inferior vena cava tumor thrombus. The use of piggyback liver transplant techniques to mobilize the liver off of the inferior vena cava provides excellent exposure of the inferior vena cava. Patients with a level II or level III inferior vena cava thrombus may be treated without using cardiopulmonary bypass.

Adrenal Gland Neoplasms ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Renal Cell ; pathology ; surgery ; Female ; Humans ; Liver Transplantation ; methods ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Vena Cava, Inferior ; pathology

OBJECTIVE: To evaluate the highly-selective regional vascular exclusion in the risk hepatectomy for liver tumor. METHODS: Short hepatic veins were ligated and divided followed by the dissection, and isolation of the inflow and outflow vessels of the tumor-bearing lobe, which were completely devascularized after the occlusion of these vessels. The blood loss volume, postoperative recovering situation of the liver function and the incidence of complication were observed in 68 cases. RESULTS: Main hepatic veins were dissected and isolated exo-hepatically in 65 cases. In the other 3 cases, the main hepatic veins were blocked by Satin skin clamp applied longitudely along the inferior vena cava. Hepatic pedicle was routinely excluded.The amount of blood loss was from 400 to 1200 (600+/-200) mL and 26 (65%) cases didn't receive transfusion.There was no operative mortality and liver function failure. Surgical complications included subphrenic abscess in 2 cases and bile leakage in 2 cases, which were cured conservatively. CONCLUSION Highly-selective regional exclusion of hepatic blood flow during the risk hepatectomy is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.
Adult ; Aged ; Female ; Hepatectomy ; methods ; Hepatic Veins ; surgery ; Humans ; Liver ; blood supply ; surgery ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Vena Cava, Inferior ; surgery

OBJECTIVETo present one cases of the use of balloon catheter in surgical treatment of renal angiomyolipoma involving the renal vein and vena cava as a tumor thrombus and review literatures.

METHODSAbdominal ultrasound and CT and MRI demonstrated a large right renal mass with tumor thrombus in the inferior vena cava. Right nephrectomy and en-bloc removal of the intra caval tumor thrombus were performed. A balloon catheter was used to block vena cava under the level of liver vena during the operation.

RESULTSThe pathological diagnosis was angiomyolipoma. The length of the tumor thrombus was 6.5 cm. The patient recovered well 1 year after surgery.

CONCLUSIONRenal angiomyolipoma with a tumor thrombus should be paid more attention.

Adult ; Angiomyolipoma ; complications ; surgery ; Balloon Occlusion ; Embolectomy ; methods ; Embolism ; etiology ; surgery ; Female ; Humans ; Kidney Neoplasms ; complications ; surgery ; Liver ; blood supply ; pathology ; surgery ; Nephrectomy ; Vena Cava, Inferior

We report here on a 64-year-old woman with extramedullary plasmacytoma involving the bilateral adrenal glands. Primary adrenal extramedullary plasmacytoma is extremely rare and only three cases of extramedullary plasmacytoma in the unilateral adrenal gland have currently been reported on. This case is of interest in that the bilateral adrenals were involved. In this article, we present the MRI findings and we briefly review the relevant literature.
Adrenal Gland Neoplasms/*diagnosis/surgery ; Back Pain/etiology ; Female ; Humans ; Kidney/pathology ; *Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Invasiveness ; Plasmacytoma/*diagnosis/surgery ; Vena Cava, Inferior/pathology