Mature Testicular Teratoma with Vena Caval Invasion Presenting as Pulmonary Embolism

Kwok, Chuen K.; Horowitz, Michael D.; Livingstone, Alan S.; Block, Norman L.

doi:10.1016/s0022-5347(17)36021-4

Cited by 17 publications

(14 citation statements)

References 13 publications

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“…As Kwok et al [5] reported, our patient showed a marked discor dance between the severity of the pulmonary embolism and the absence of evidence of metastatic spread. Moreover, in addition to having the spermatic cord, tunica albuginea and epididymis all free of tumor, the patient ultimately responded well to chemotherapy.…”

Section: Discussionsupporting

confidence: 75%

“…Neoplastic pulmonary embolism has rarely been re ported, and most cases were from autopsy studies [1,4]. To our knowledge, only 4 cases have been clinically recognized and in only 1 case was pulmonary embolism the initial symptom [3,[5][6][7], We report here the exceptional case of a nonseminomatous germ cell tumor presenting as a dramatic neoplastic pulmonary embolism treated by surgical thrombectomy, with excellent outcome.…”

Section: Introductionmentioning

confidence: 94%

“…Recently, Kwok et al [5] reported on a patient with mature testic ular teratoma with invasion and thrombosis of the IVC presenting as recurrent pulmonary embolism. In this case, the patient was treated without surgical thrombectomy, and the composition of the pulmo nary thrombus was not specified.…”

Section: Clinical Presentationmentioning

confidence: 99%

See 2 more Smart Citations

Testicular Neoplasm Presenting as a Major Pulmonary Embolism

Haab¹,

Cour²,

A³

et al. 1996

Eur Urol

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 94%

See 1 more Smart Citation

Testicular Neoplasm Presenting as a Major Pulmonary Embolism

Haab¹,

Cour²,

A³

et al. 1996

Eur Urol

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“…Renal cell carcinoma is the most common cause, 1 but germ cell tumor, retroperitoneal leiomyosarcoma, adrenal cortical carcinoma, renal angiomyolipoma, and hepatic hemangioma have been reported as other causes. [2][3][4][5][6][7] In this case, a germ cell tumor was associated with IVC thrombosis. Germ cell tumor is the most frequent malignancy in men aged 18-35 years.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Pulmonary Embolism in Young Man With Retroperitoneal Tumor Despite Insertion of Temporary IVC Filter

Natsuaki

Numaguchi

Tada

et al. 2009

Circ J

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A 21-year-old man was admitted to our hospital for acute chest pain and dyspnea. On arrival, his blood pressure was 110/40 mmHg and heart rate was 112 beats/min. In the arterial blood gas analysis, pH was 7.43, PaCO2 was 31 mmHg, and PaO2 was 92 mmHg under 10 L/min oxygen inhalation. In the blood tests, blood cell count and renal functions were normal, but lactate dehydrogenase and C-reactive protein levels were high at 590 IU/L and 3.7 mg/dl, respectively. Of the coagulation values, the d-dimer level was high (13.7 μg/ml), and ATIII activity was slightly low (60%), but the activities of protein C and protein S were normal. Plain chest X-ray showed mild pulmonary artery dilatation. Ultrasonic cardiogram (UCG) showed right ventricle overload and pulmonary hypertension (estimated systolic pulmonary artery pressure 60 mmHg). We suspected pulmonary embolism (PE), and performed contrast computed tomography (CT), which revealed massive thrombi in both pulmonary arteries ( Figure 1A). Bilateral perfusion defects were found on perfusion scintigraphy of the lung ( Figure 1B), and we diagnosed PE. In addition, abdominal CT showed a retroperitoneal tumor approximately 10×5 cm (Figure 2A). The inferior vena cava (IVC) was obstructed by the tumor and thrombus existed in the right common iliac vein. We started thrombolysis (urokinase 240,000 U/day for 5 days) followed by heparinization (48,000 U/day). We controlled the APTT at 60-80 s. Under this therapy, his oxygen saturation and symptoms improved each day and on the 3 rd day, arterial blood gas analysis showed that pH was 7.43, PaCO2 was 40 mmHg, and PaO2 was 88 mmHg under room air. The pulmonary artery pressure had also decreased on UCG (estimated systolic pulmonary artery Japan. E-mail: natsuaki@saiseikai-hp.chuo.fukuoka.jp All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Recurrence of Pulmonary Embolism in Young Man With Retroperitoneal Tumor Despite Insertion of Temporary IVC FilterMasahiro Natsuaki, MD; Kotaro Numaguchi, MD; Hideo Tada, MD*; Yuichiro Nakashima, MD**; Masanori Okabe, MD; Yusuke Yamamoto, MD Pulmonary embolism (PE) is a fatal disease that is very rare in young people. A 21-year-old man developed PE because of a retroperitoneal tumor. The inferior vena cava (IVC) was obstructed by the tumor, and thrombus existed in the right common iliac vein. Thrombolysis and heparinization improved his symptoms prior to urgent tumor resection. A temporary IVC filter was inserted the day before the operation, but 8 h later fatal massive PE occurred. At autopsy, the retroperitoneal tumor was revealed as a metastatic choriocarcinoma. Prophylactic use of a temporary IVC filter might have paradoxically induced recurrence of massive PE in this case. (Circ J 2009; 73: 1756 -1758

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“…4 -11 Because of the rapid shrinkage of large tumor masses that can occur during chemotherapy, there is the possibility of significant morbidity and mortality from pulmonary embolism in patients with IVCO. 4,5,18 We have described 31 cases of IVCO secondary to metastatic GCT. Approximately 33% of patients with IVCO secondary to metastatic GCT had thromboembolic complications, with 1 case of fatal pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%