Wilms' tumor with vena caval, atrial, and middle hepatic vein tumor thrombus.
A 3-year-old male with a right-sided Wilms' tumor presented with tender hepatomegaly and bilateral lower-limb edema. Ultrasound and echocardiography showed a massive tumor thrombus completely occluding the inferior vena cava, right atrial cavity, and extending retrogradely into the middle hepatic vein. Two courses of preoperative chemotherapy (vincristine, actinomycin D, adriamycin) caused minimal shrinkage of the thrombus. The tumor and thrombus were successfully removed with the patient under cardiopulmonary bypass and deep hypothermic circulatory arrest followed by multiagent chemotherapy (vincristine, actinomycin D, adriamycin, cyclophosphamide). The child is alive and well with no evidence of disease 15 months later. Occlusion of the hepatic vein by a tumor thrombus in Wilms' tumor is a very rare event. It was completely removed by the right atrial route under direct vision in this child.
Sripathi
V
V
The Childs Trust Hospital, Nugambakkam, Chennai, India.
Muralidharan
K V
KV
Ramesh
S
S
Muralinath
S
S
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004452:Echocardiography; D006325:Heart Atria; D006503:Hepatic Veins; D006801:Humans; D008297:Male; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D014682:Vena Cava, Inferior; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000150:complications* / Q000188:drug therapy / Q000601:surgery
D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide