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首页> 外文期刊>DMW: Deutsche Medizinische Wochenschrift >Organ-invasive carcinoma of the pararenal gland involving the inferior vena cava: Successful curative and interdisciplinary surgical management [Organ??berschreitendes Nebennierenrindenkarzinom mit Beteiligung der Vena cava inferior: Kurativ erfolgreiches interdisziplin?r-operatives Management]
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Organ-invasive carcinoma of the pararenal gland involving the inferior vena cava: Successful curative and interdisciplinary surgical management [Organ??berschreitendes Nebennierenrindenkarzinom mit Beteiligung der Vena cava inferior: Kurativ erfolgreiches interdisziplin?r-operatives Management]

机译：涉及下腔静脉的肾旁腺的器官浸润癌：成功的治愈和跨学科手术管理

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History and admission findings: A 61-year-old woman presented with a 2-month-history of progressive deterioration, increasing exertional dyspnoea and pain in the right upper abdomen (past medical history: bronchial asthma and hypertension). The physical examination showed mild generalized weakness, tenderness in the right upper abdomen, and ascites. Investigations: Laboratory studies did not reveal any hormonal abnormalities. A CT angiogram revealed a mass of the right adrenal gland with distinct invasion into the inferior vena cava, and tumour thrombosis that extended proximally into the right atrium. Distally, the tumour ended at the caudate lobe of the liver with an extensive peripherally engulfed thrombus from the inferior vena cava down to the common iliac veins. Treatment and course: An open right adrenalectomy with resection of the periadrenal tissue and extirpation of the intracaval tumour thrombus (by cavotomy under digital occlusion of the blood flow from the vena cava into the right atrium) was carried out with no significant postoperative complications. Subsequently, the patient underwent adjuvant mitotane therapy for three years. So far, no recurrence has occurred during a course of 7 years. Conclusion: Tumour induced thrombotic occlusion of the inferior vena cava and other veins is rare, especially with right atrium involvement. In the absence of other effective treatment options, the combination of radical resection and adjuvant mitotane therapy remains the only successful curative treatment for primary invasive adrenal gland carcinoma. ? Georg Thieme Verlag KG - Stuttgart - New York.
机译：病史和入院检查结果：一名61岁的女性，有2个月的病史，病情进展为右上腹部逐渐恶化，劳累性呼吸困难和疼痛加剧（过去的病史：支气管哮喘和高血压）。体格检查显示轻度全身无力，右上腹压痛和腹水。调查：实验室研究未发现任何激素异常。 CT血管造影显示右肾上腺肿块，明显侵犯下腔静脉，肿瘤血栓形成向近端延伸至右心房。从远处看，肿瘤终止于肝脏的尾状叶，从下腔静脉到down总静脉有广泛的周边吞噬血栓。治疗和病程：进行了一个开放性的右肾上腺切除术，切除了肾上腺周围组织并切除了腔内肿瘤血栓（通过腔静脉在从腔静脉进入右心房的血流进行数字闭塞的情况下进行开颅术），没有明显的术后并发症。随后，该患者接受了米诺坦辅助治疗三年。到目前为止，在7年的时间里没有复发。结论：肿瘤引起的下腔静脉和其他静脉的血栓闭塞很少见，尤其是右心房受累。在没有其他有效的治疗选择的情况下，根治性切除和米线烷辅助疗法的结合仍然是原发性浸润性肾上腺癌唯一成功的治疗方法。 ？ Georg Thieme Verlag KG-斯图加特-纽约。

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