Jibiki Masatoshi, Inoue Yoshinori, Sugano Norihide, Iwai Takehisa, Katou Tomoyasu
Department of Vascular and Applied Surgery, Tokyo Medical and Dental University, Graduate School, 1-5-45 Yushima, Tokyo, 113-8519, Japan.
Surg Today. 2006;36(5):465-9. doi: 10.1007/s00595-005-3175-4.
Endometrial stromal sarcoma (ESS) rarely extends into the inferior vena cava (IVC). Two cases of ESS extending into the IVC were encountered. In the first case a low-grade sarcoma and cavography revealed the tumor thrombus to extend to just below the left renal vein from the right internal iliac vein, and the IVC was patent. A tumor thrombectomy was accomplished to prevent pulmonary embolism (PE) and to achieve a good prognosis. The second case was also a low-grade sarcoma. Abdominal computed tomography scanning revealed a large thrombus extending into the IVC just below the hepatic vein. A tumor thrombectomy with an IVC resection was performed. The postoperative course was uneventful for both cases. Aggressive surgical treatment is thus recommended to excise a tumor thrombus with or without an IVC resection in patients with ESS of low-grade malignancy extending into the IVC to prevent sudden death due to PE.
子宫内膜间质肉瘤（ESS）很少蔓延至下腔静脉（IVC）。我们遇到了两例ESS蔓延至IVC的病例。第一例为低级别肉瘤，静脉造影显示肿瘤血栓从右髂内静脉延伸至左肾静脉下方，IVC通畅。进行了肿瘤血栓切除术以预防肺栓塞（PE）并获得良好预后。第二例也是低级别肉瘤。腹部计算机断层扫描显示一个大血栓延伸至肝静脉下方的IVC。进行了肿瘤血栓切除术并切除了部分IVC。两例患者术后病程均平稳。因此，对于低级别恶性ESS蔓延至IVC的患者，建议采取积极的手术治疗，切除肿瘤血栓，可根据情况决定是否切除IVC，以预防因PE导致的猝死。
