Limits...
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

Endoscopic images of gastric tumor
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Endoscopic images of gastric tumor

Mentions: She was followed in the outpatient oncology clinic and was scheduled for a total of six cycles of capecitabine with oxaliplatin. Her course was complicated by gastrointestinal bleeding from the gastric tumor after the fourth cycle of chemotherapy (Fig. 4). Esophagogastroduodenoscopy revealed a tumor that was unamenable to endoscopic therapy. She then recovered from gastrointestinal bleeding. Her HER2 test result was positive before the continuation of additional cycles of capecitabine and oxaliplatin, and she was thus started on trastuzumab 8mg/kg and paclitaxel 175mg/m2. She reported improvement in her appetite and energy level at her follow-up visits, though she continued to have abdominal bloating. At the time this writing, she was in cycle 5 of paclitaxel and trastuzumab.Fig. 4


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)

Endoscopic images of gastric tumor
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Endoscopic images of gastric tumor
Mentions: She was followed in the outpatient oncology clinic and was scheduled for a total of six cycles of capecitabine with oxaliplatin. Her course was complicated by gastrointestinal bleeding from the gastric tumor after the fourth cycle of chemotherapy (Fig. 4). Esophagogastroduodenoscopy revealed a tumor that was unamenable to endoscopic therapy. She then recovered from gastrointestinal bleeding. Her HER2 test result was positive before the continuation of additional cycles of capecitabine and oxaliplatin, and she was thus started on trastuzumab 8mg/kg and paclitaxel 175mg/m2. She reported improvement in her appetite and energy level at her follow-up visits, though she continued to have abdominal bloating. At the time this writing, she was in cycle 5 of paclitaxel and trastuzumab.Fig. 4

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