A case of carcinoma of the lower lip with superior vena cava syndrome due to secondary mediastinal lymph node metastasis

Abstract

We report a case of carcinoma of the lower lip with superior vena cava syndrome(SVCS)due to secondary metastasis to the mediastinal lymph nodes. The patient, a 77 year-old woman, was referred to our department to treat a tumor in the right side of the lower lip. Histologic examination of a biopsy specimen revealed a well-differentiated squamouse cell carcinoma. The tumor was abraded by en bloc excision surgery with bilateral neck dissection under general anesthesia. Further histological evaluation of an excised specimen revealed a diagnosis of pN2c. Six months later the cancer recurred locally in the left corner of the patient' s mouth, and the tumor was removed surgically. Eight months later, edema suddenly developed on the left side of the face, neck, forearm, and back of hand, accompanied by dizziness. A computed tomographic scan of the patient' s chest revealed metastasis to the left mediastinal lymph nodes, with occlusion of the left internal jugular vein, brachiocephalic veins, and respiratory tract. The occulded veins were attributed to compression of the superior vena cava by a metastatic tumor. SVCS should be considered whenever edema of the face appears after neck dissection.

Mediastinum Lymph Node Metastasis with Superior Vena Cava Syndrome

“…Radiation therapy has long been considered a mainstay of SVCS treatment [4]. Some hospitals [1,2] reported that radiation therapy could be effective in cases in which the symptoms needed to be relieved urgently when the general condition was poor, as in our case. Straka C, et al [4] described that hypo-fractionated RT had the potential to be a more convenient therapy for patients and may provide equal or superior control of underlying malignancies.…”

“…CT and MRI studies are commonly used in the initial evaluation of SVCS and can reveal SVC blockage prior to the development of symptoms. After cancer treatment and when following patients with cancercarrier conditions, it is necessary to keep in mind the possibility of SVCS due to longitudinal lymph node metastasis, as well as chest and mediastinum tumors if rapid facial edema appears [2].…”

“…Concerning SVCS therapies, many of the causable diseases of SVCS are malignant tumors. Radiotherapy, chemotherapy with anticancer drugs, and single or combined surgical therapy are usually selected [2,5,6]. Liu H, et al [7] reported that, for SVCS caused by malignant tumors, percutaneous endoluminal stent therapy could quickly and effectively relieve the clinical symptoms of patients, and the incidence…”

“…Open Access Journal of complications was low. Nanbu H, et al [2] described that, when chemotherapy or radiotherapy was not available, intravascular stenting was effective in preventing SVC occlusion. In addition, as other symptomatic therapies, he described that the administration of diuretics and corticosteroid drugs may be useful for the prevention of edema.…”

“…Superior vena cava (SVC) is known to be susceptible to pressure from surrounding tissues due to various conditions such as its anatomical position, histological features of thin walls, and low blood pressure in the vassal canal [1]. Superior vena cava syndrome (SVCS) is a generic term for a syndrome in which compression or obstruction of the SVC impairs the return of venous blood to the heart and causes venous depression in the head, neck, chest, and upper limbs [2]. In the etiology of SVCS, most cases (85%) occur in the presence of malignant disease, particularly bronchogenic carcinomas, lymphomas and metastatic tumors [3].…”