Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium - A case report.

Autor:	Lad PP; Department of Surgical Oncology, Om Sai Onco-Surgery Center, R/S no 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, 416006, India. Electronic address: drprashantlad@gmail.com., Kumar J; Sai Cardiac Center, 2021/B, 6th lane S.T Colony, Mahalaxminagar, Rajarampuri, Kolhapur, Maharashtra, 416008, India. Electronic address: kumarjateendar@hotmai.com., Sarvadnya J; Department of Head and Neck Surgery, Om Sai Onco-Surgery Center, R/S number 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, 416006, India. Electronic address: jjsonco@gmail.com., Powar AS; Department of Surgical Oncology, Om Sai Onco-Surgery Center, R/S number 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, 416006, India. Electronic address: abhijitpowar009@gmail.com.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2020; Vol. 66, pp. 48-52. Date of Electronic Publication: 2019 Nov 01.
DOI:	10.1016/j.ijscr.2019.10.050
Abstrakt:	Introduction: Differentiated thyroid carcinoma with an extensive intravenous tumor thrombus which is extending into internal jugular vein (IJV), superior vena cava (SVC) and right atrium (RA) is a rare clinical finding. We report a multimodal staged surgical approach for this life threatening complicated case. Presentation of Case: A 52 year old female, presented with diffuse thyroid swelling, FNAC revealed it as follicular thyroid neoplasm. Computed tomography (CT) scan showed tumor thrombus extending into IJV, SVC and right atrium (RA). We planned complete resection of tumor in two stage operation. Initially in first stage, cardio-thoracic surgery was done to remove SVC and RA thrombus to eliminate the immediate risk of pulmonary embolism. In the second stage, neck surgery was performed to resect thyroid tumor and to perform extensive thrombectomy in the cervical veins. This patient has been followed for one year after successful surgery without recurrence. Discussion: Venous involvement by follicular thyroid carcinoma reaching to RA is a rare life threatening condition. Though there is no standard guidelines available, treatment strategies should be discussed and planned among multidisciplinary team. Intraluminal extension is not a contraindication for aggressive surgical management. It will avoid fatal pulmonary embolism, as well as improve overall survival of the patient. Conclusion: Invasion of the great vessels by thyroid carcinoma is usually associated with early relapse and poor prognosis, but if tumor in the blood vessel is resected completely, a better prognosis is possible. Two staged surgical approach is safe and gives a predictable outcome. Competing Interests: Declaration of Competing Interest I have no conflicts of interest to disclose concerning this case report. (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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