The management of inferior vena cava obstruction complicating metastatic germ cell tumors

✍ Scribed by Bass Hassan; Ken Tung; Richard Weeks; Graham M. Mead

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 77 KB
• Volume: 85
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/(sici)1097-0142(19990215)85:4<912::aid-cncr20>3.0.co;2-5

✦ Synopsis

Background:

Inferior vena cava obstruction (ivco) is a poorly characterized complication of metastatic germ cell tumor (gct). the authors identified 31 cases to describe the clinical features, radiologic findings, complications, and treatment of this clinical entity.

Methods:

Patients with gct and ivco were identified from case records of a gct database. the records of 333 male patients with metastatic gct (27% with seminoma and 73% with nonseminomatous gcts) were screened for either clinical or computed tomography (ct) scan evidence of inferior vena cava compression or involvement.

Results:

Thirty-one patients were identified (9.3% of patients with metastatic gct). common presenting symptoms were leg swelling and dilated abdominal wall veins. approximately 29% of patients had thromboembolic complications and there was a single case of fatal pulmonary embolism. nine patients had no clinical features at presentation but either had ct scan evidence of ivco or developed symptoms during treatment. right-sided testicular primary tumors were associated more frequently with ivco compared with left-sided primary tumors (14% vs. 4% of cases of metastatic gct, respectively). all patients had an abdominal mass measuring > 5 cm in maximum transverse dimension.

Conclusions:

The authors recommend careful clinical and radiologic evaluation for the presence of ivco in cases of bulky metastatic gct. a high index of suspicion must accompany the evaluation of a patient with a right-sided primary testicular tumor and a paracaval abdominal mass measuring > 5 cm in maximum transverse dimension. when ivco is identified, prophylactic anticoagulation is recommended.