巨大腎腫瘤導致下腔靜脈壓迫之個案報告

梁柏崧  石宏仁  黃勝賢  陳一中

彰化基督教醫院外科部泌尿外科

Large renal tumor inducing compression of the inferior vena cava: A case report

Po-Sung Liang, Hung-Jen Shih, Sheng-Hsien Huang, Yi-Zhong Chen

Division of Urology, Department of Surgery, Changhua Christian Hospital

Introduction:

Renal masses can be categorized into various types based on pathological characteristics. Liposarcoma is a malignant kind of renal tumor. Dedifferentiated liposarcoma is an exceedingly aggressive and high-grade form of liposarcoma. It is a swiftly expanding tumor that evolves from well-differentiated liposarcoma. Dedifferentiated liposarcomas exhibit characteristics of high-grade sarcomas, capable of metastasizing to distant sites such as the lungs, liver, bones, skin, soft tissue, and brain, resulting in a poorer prognosis.

Case presentation:

A 68-year-old male patient with a history of type 2 diabetes mellitus and chronic hepatitis B reported with right flank pain and abdominal distension for several months. An abdomen ultrasound indicated a substantial, complex kidney cyst containing a soft tissue component. A follow-up contrast-enhanced computed tomography (CT) scan verified the existence of a lobulated, heterogeneous cystic mass near the upper pole of the right kidney, measuring 12 × 9 cm, exhibiting slight contrast enhancement. The tumor was exerting considerable compression on the neighboring inferior vena cava (IVC), which was seen as a thin line on coronal and transverse imaging. The patient underwent a hand-assisted laparoscopic right radical nephrectomy, during which significant adhesions to the duodenum and inferior vena cava were found. A partial serosal laceration of the duodenum was sutured during the procedure. The cardiovascular surgeon was consulted to aid in the release of the adhesion to the inferior vena cava (IVC), and a subcostal incision was performed to enable dissection between the renal tumor and the IVC. A partial tear of the IVC layer occurred during dissection and was promptly fixed with 4-0 prolene sutures. The renal tumor was effectively removed, and pathology verified it as a dedifferentiated liposarcoma with clean margins. The patient was then initiated on adjuvant immunotherapy with pembrolizumab.

Conclusions:

Dedifferentiated liposarcoma can proliferate rapidly, leading to compression of adjacent organs and significant adhesion; hence, meticulous anatomical identification and prompt surgical intervention are crucial.