Unusual Presentation of Testicular Cancer with Tumor Thrombus Extending to the Inferior Vena Cava

Abstract

A 45-year-old man with a left testis tumor with a 25 mm para-aortic lymph node swelling, multiple bilateral pulmonary metastases, bilateral pulmonary embolism, and inferior vena cava (IVC) thrombus underwent a radical orchidectomy in our institution. The thrombus extended from the left gonadal vein to the left renal vein to the IVC. The fluorine-18 fluorodeoxyglucose (f-FDG) positron emission tomography (PET) computerized tomography (CT) demonstrated a hypermetabolic focus in the retroperitoneum and in the IVC thrombus. Before orchidectomy only lactate dehydrogenase (LDH) was high but all the serum tumor markers increased postoperatively. The tumor was staged pT1N2M1aS1, which was an intermediate prognosis, based on the International Germ Cell Cancer Collaborative Group consensus (IGCCCG). After 4 courses of bleomycin, etoposide, and cisplatin (BEP) chemotherapy the patient's tumor markers normalized and the thrombus disappeared. There was only one residual retroperitoneal lymph node M1. Retroperitoneal lymph node dissection was performed. The pathological examination revealed only necrotic tissues. The patient has been disease-free since surgery.

IVC tumoural thrombosis: an unusual complication of testicular tumour

“…Hassan et al 1 described few cases of GCT with IVC thrombosis and stressed that high index of suspicion is needed in right-sided testicular tumours associated with retroperitoneal LN masses >5 cm. IVC thrombosis in our case completely regressed after chemotherapy, although Dusaud et al 2 described rare regression of IVC thrombosis with chemotherapy alone, with patients ultimately requiring thrombectomy.…”

Tumor thrombus: incidence, imaging, prognosis and treatment

“…While autopsy reports have suggested the incidence of tumor thrombus to be as high as 11%, it is only seen in 1% of cases by imaging (123,124). In addition to tumor thrombus originating from the primary site and extending into the gonadal veins, retroperitoneal metastatic lymphadenopathy may grow directly into the IVC (125). There are variable approaches to treatment of testicular cancer in the setting of tumor thrombus; some advocate retrievable IVC filter placement prior to definitive therapy, others employ neoadjuvant chemotherapy, still others advocate chemotherapy alone and finally some support early primary surgical resection (126)(127)(128).…”

Syncope as the initial presentation of pulmonary embolism in a young adult with testicular tumor

“…TT can involve IVC through several mechanisms. The first is a hematogenous spread of the tumor that directly invades the right spermatic vein and then spreads into the IVC, [21] which explains why IVC invasion occurs more frequently in patients with right TT. The second explanation is a lymphatic spread and local invasion of retroperitoneal enlarged lymph nodes.…”

“…For patients with IVC thrombosis that extends into the cardiac chambers, appropriate treatment includes chemotherapy and surgery. [21]…”