Extensive cavo-atrial and hepatic venous tumor thrombus in a mismanaged retroperitoneal pediatric germ cell tumor: A unique surgical challenge

• Published in: Annals of hepato-biliary-pancreatic surgery Vol. 25; no. 4; pp. 528 - 531
• Main Authors: Kazi, Mufaddal, Kaushik, Pradeep, Saini, Shivpal, Premchandani, Dhiraj, Qureshi, Sajid Shafique
• Format: Journal Article
• Language: English
• Published: 한국간담췌외과학회 01-11-2021; The Korean Association of Hepato-Biliary-Pancreatic Surgery
• Subjects: Case Report; 일반외과학; Tumor thrombosis; Hepatic veins; Germ cell neoplasm; Inferior vena cava
• ISSN: 2508-5778; 2508-5859
• DOI: 10.14701/ahbps.2021.25.4.528

Retroperitoneal germ cell tumor with tumor thrombosis of the inferior vena cava (IVC) represents a rare phenomenon. Its extension to the hepatic veins (HVs) has not been reported yet. In the present case, a 30-month-old girl had a recurrent retroperitoneal yolk sac tumor with liver metastasis. In addition, there were tumor thrombi in the IVC, right atrium (RA), and all three HVs. The child was operated after a satisfactory response to chemotherapy. Excision of the retroperitoneal tumor with right hepatectomy, retrohepatic caval resection, HV, and RA thrombectomy was performed under a cardiac bypass. HV cloaca was patched with pericardium while the IVC resection was tolerated without reconstruction. Her postoperative recovery was normal. The child currently remains disease-free and symptom-free at 12 months. This case demonstrates the technique of hepatic venous thrombectomy and the feasibility of radical surgery even for a metastatic disease when tumor biology is favorable. Despite wide-spread tumor thrombosis that would have been deemed unresectable, complete resections are possible in referral centers.