Kazi Mufaddal, Kaushik Pradeep, Saini Shivpal, Premchandani Dhiraj, Qureshi Sajid Shafique
Division of Paediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India.
Department of Paediatric Cardiac Surgery, SRCC Children's Hospital-Narayana Health, Mumbai, India.
Ann Hepatobiliary Pancreat Surg. 2021 Nov 30;25(4):528-531. 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.
伴有下腔静脉（IVC）瘤栓形成的腹膜后生殖细胞肿瘤是一种罕见现象。其累及肝静脉（HVs）的情况尚未见报道。在本病例中，一名30个月大的女孩患有复发性腹膜后卵黄囊瘤并伴有肝转移。此外，下腔静脉、右心房（RA）以及所有三支肝静脉内均有瘤栓。该患儿在对化疗有满意反应后接受了手术。在体外循环下进行了腹膜后肿瘤切除、右肝切除、肝后下腔静脉切除、肝静脉和右心房瘤栓清除术。肝静脉汇合处用心包修补，而下腔静脉切除后未进行重建且患儿耐受良好。她术后恢复正常。该患儿目前在12个月时仍无疾病且无症状。本病例展示了肝静脉瘤栓清除术的技术，以及即使对于转移性疾病，在肿瘤生物学特性有利时进行根治性手术的可行性。尽管存在广泛的瘤栓形成，以往会被认为无法切除，但在转诊中心完全切除是可行的。
