Intraoperative detection of inferior vena caval tumor thrombus extending from metastatic lymph node of renal cell carcinoma using ultrasonography
Intraoperative detection of inferior vena caval tumor thrombus extending from metastatic lymph node of renal cell carcinoma using ultrasonography
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DOI：
10.1007/s10396-017-0838-x
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发表时间：
2018-04-01
影响因子：
1.8
通讯作者：
Ishizuka, Osamu
中科院分区：
文献类型：
--
作者：
Minagawa, Tomonori;Fukui, Daisuke;Ishizuka, Osamu
一位67岁男性因肉眼血尿来我科就诊。计算机断层扫描（CT）显示一个巨大的肾脏肿瘤伴腔静脉旁转移性淋巴结（mLN）。术前诊断为肾细胞癌的肾脏肿瘤计划进行右侧全肾切除术。就在切除肾静脉和动脉之前，术中超声检查显示从mLN延伸的下腔静脉癌栓（IVCTT）。超声检查清楚地动态显示了下腔静脉内的血管壁有节奏的摆动运动，并伴有下腔静脉内的血流。右肾根治性切除术后，IVCTT切除血管壁，以减少肺肿瘤血栓的风险。组织病理学诊断为肾透明细胞癌，切除的IVCTT经组织病理学证实为肾细胞癌mLN的肿瘤累及。术中超声检查可以检测到从mLN延伸的IVCTT，而CT不能。
A 67-year-old man consulted our department with gross hematuria. Computed tomography (CT) revealed a huge renal tumor with a paracaval metastatic lymph node (mLN). Right total nephrectomy was planned for the renal tumor diagnosed as renal cell carcinoma preoperatively. Just before the resection of the renal vein and artery, intraoperative ultrasonography revealed an inferior vena caval tumor thrombus (IVCTT) extending from the mLN. Ultrasonography clearly and dynamically demonstrated a rhythmic flapping movement of the IVCTT with blood flow in the inferior vena cava. Following right radical nephrectomy, IVCTT resection with the vessel wall was performed to reduce the risk of pulmonary tumor thrombus. Histopathological diagnosis of the renal tumor was clear cell renal cell carcinoma, and the resected IVCTT was confirmed histopathologically as tumor involvement from the mLN of the renal cell carcinoma. Intraoperative ultrasonography can detect IVCTT extending from the mLN, whereas CT cannot.