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The inferior vena cava (IVC) syndrome as the initial manifestation of newly diagnosed gastric adenocarcinoma: a case report.

Patel SA - J Med Case Rep (2015)

Bottom Line: The superior vena cava syndrome, which is characterized by facial plethora, jugular venous distension, and arm swelling, is a well-known entity associated with bronchogenic carcinoma.She had significant worsening of leg swelling after standing for short periods of time.Prompt initiation of treatment, including chemotherapy or vena cava stent placement, can result in improved patient outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Stanford Hospital and Clinics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA. shyam2@stanford.edu.

ABSTRACT

Introduction: Vena cava compression is a relatively rare initial manifestation of underlying malignancy. The superior vena cava syndrome, which is characterized by facial plethora, jugular venous distension, and arm swelling, is a well-known entity associated with bronchogenic carcinoma. Less common is the compression of the inferior vena cava. To the best of my knowledge, this is the first reported case of newly diagnosed gastric adenocarcinoma presenting initially as the inferior vena cava syndrome. The unique aspect about this case is that it highlights a rare presentation before diagnosis of gastric adenocarcinoma.

Case presentation: A 56-year-old Malaysian woman with a past medical history of iron deficiency anemia presented with lower extremity edema and progressive fatigue of 1 month's duration. She had significant worsening of leg swelling after standing for short periods of time. She also reported epigastric discomfort, which led to an additional workup, including computed tomography of the abdomen and pelvis. This revealed a 3cm×2.9cm mass in the stomach, extensive hepatic metastasis, and severe inferior vena cava compression. The patient was examined further with esophagogastroduodenoscopy, and a biopsy showed gastric adenocarcinoma.

Conclusions: This report describes a case of a patient with inferior vena cava syndrome as a unique presentation of previously undiagnosed stage IV gastric adenocarcinoma. Patients presenting with inferior vena cava syndrome should undergo prompt evaluation for underlying malignancies that have a predilection for hepatic metastasis. This case is important because earlier recognition of this syndrome can lead to earlier workup and thus detection of malignancy. Prompt initiation of treatment, including chemotherapy or vena cava stent placement, can result in improved patient outcome.

No MeSH data available.


Related in: MedlinePlus

Adenocarcinoma involving the antrum of the stomach. Computed tomographic scan of the abdomen and pelvis with intravenous contrast shows an ill-defined 3cm×2.9cm necrotic mass. Scan also reveals omental implants and nodular extension of the gastric tumor posteriorly into the lesser sac
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Fig2: Adenocarcinoma involving the antrum of the stomach. Computed tomographic scan of the abdomen and pelvis with intravenous contrast shows an ill-defined 3cm×2.9cm necrotic mass. Scan also reveals omental implants and nodular extension of the gastric tumor posteriorly into the lesser sac

Mentions: The differential diagnosis included pulmonary embolism and myocardial injury or ischemia. Her troponin level was negative. An ultrasound of the lower extremities showed no deep vein thrombosis. Computed tomography (CT) of the abdomen and pelvis revealed severe intrahepatic narrowing of the IVC due to mass effect (Fig. 1) and an ill-defined 3cm×2.9cm mass involving the antrum of the stomach (Fig. 2). The CT scans were also notable for omental implants and nodular extension of the gastric tumor posteriorly into the lesser sac. She had a small amount of ascites. The gastric mass was biopsied during endoscopy (initially at an outside hospital). The histologic sections of the gastric antrum mass biopsy revealed an invasive, moderately differentiated adenocarcinoma of intestinal type, with formation of glands and nests (Fig. 3). The biopsy had a pancytokeratin-positive neoplasm. The patient was started on chemotherapy with capecitabine 1500mg by mouth twice daily and oxaliplatin 130mg/m2. The interventional radiology team evaluated the patient for possible IVC stent placement at a later time with the goal of alleviating venous obstruction. IVC stent placement was deferred while the patient was an inpatient because this procedure was typically reserved as palliative treatment for patients in whom chemotherapy has limited utility or for patients who have a poor response to chemotherapy.Fig. 1


The inferior vena cava (IVC) syndrome as the initial manifestation of newly diagnosed gastric adenocarcinoma: a case report.

Patel SA - J Med Case Rep (2015)

Adenocarcinoma involving the antrum of the stomach. Computed tomographic scan of the abdomen and pelvis with intravenous contrast shows an ill-defined 3cm×2.9cm necrotic mass. Scan also reveals omental implants and nodular extension of the gastric tumor posteriorly into the lesser sac
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4584485&req=5

Fig2: Adenocarcinoma involving the antrum of the stomach. Computed tomographic scan of the abdomen and pelvis with intravenous contrast shows an ill-defined 3cm×2.9cm necrotic mass. Scan also reveals omental implants and nodular extension of the gastric tumor posteriorly into the lesser sac
Mentions: The differential diagnosis included pulmonary embolism and myocardial injury or ischemia. Her troponin level was negative. An ultrasound of the lower extremities showed no deep vein thrombosis. Computed tomography (CT) of the abdomen and pelvis revealed severe intrahepatic narrowing of the IVC due to mass effect (Fig. 1) and an ill-defined 3cm×2.9cm mass involving the antrum of the stomach (Fig. 2). The CT scans were also notable for omental implants and nodular extension of the gastric tumor posteriorly into the lesser sac. She had a small amount of ascites. The gastric mass was biopsied during endoscopy (initially at an outside hospital). The histologic sections of the gastric antrum mass biopsy revealed an invasive, moderately differentiated adenocarcinoma of intestinal type, with formation of glands and nests (Fig. 3). The biopsy had a pancytokeratin-positive neoplasm. The patient was started on chemotherapy with capecitabine 1500mg by mouth twice daily and oxaliplatin 130mg/m2. The interventional radiology team evaluated the patient for possible IVC stent placement at a later time with the goal of alleviating venous obstruction. IVC stent placement was deferred while the patient was an inpatient because this procedure was typically reserved as palliative treatment for patients in whom chemotherapy has limited utility or for patients who have a poor response to chemotherapy.Fig. 1

Bottom Line: The superior vena cava syndrome, which is characterized by facial plethora, jugular venous distension, and arm swelling, is a well-known entity associated with bronchogenic carcinoma.She had significant worsening of leg swelling after standing for short periods of time.Prompt initiation of treatment, including chemotherapy or vena cava stent placement, can result in improved patient outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Stanford Hospital and Clinics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA. shyam2@stanford.edu.

ABSTRACT

Introduction: Vena cava compression is a relatively rare initial manifestation of underlying malignancy. The superior vena cava syndrome, which is characterized by facial plethora, jugular venous distension, and arm swelling, is a well-known entity associated with bronchogenic carcinoma. Less common is the compression of the inferior vena cava. To the best of my knowledge, this is the first reported case of newly diagnosed gastric adenocarcinoma presenting initially as the inferior vena cava syndrome. The unique aspect about this case is that it highlights a rare presentation before diagnosis of gastric adenocarcinoma.

Case presentation: A 56-year-old Malaysian woman with a past medical history of iron deficiency anemia presented with lower extremity edema and progressive fatigue of 1 month's duration. She had significant worsening of leg swelling after standing for short periods of time. She also reported epigastric discomfort, which led to an additional workup, including computed tomography of the abdomen and pelvis. This revealed a 3cm×2.9cm mass in the stomach, extensive hepatic metastasis, and severe inferior vena cava compression. The patient was examined further with esophagogastroduodenoscopy, and a biopsy showed gastric adenocarcinoma.

Conclusions: This report describes a case of a patient with inferior vena cava syndrome as a unique presentation of previously undiagnosed stage IV gastric adenocarcinoma. Patients presenting with inferior vena cava syndrome should undergo prompt evaluation for underlying malignancies that have a predilection for hepatic metastasis. This case is important because earlier recognition of this syndrome can lead to earlier workup and thus detection of malignancy. Prompt initiation of treatment, including chemotherapy or vena cava stent placement, can result in improved patient outcome.

No MeSH data available.


Related in: MedlinePlus