Primary mediastinal large cell neuroendocrine carcinoma presenting with superior vena cava syndrome treated with endovascular stenting: A case report
Tóm tắt
Background
Superior vena cava syndrome (SVCS) is a potential fatal oncologic emergency that requires immediate intervention.
Methods
A 65-year-old male patient presented with recurrent syncopal attacks, difficulty of breathing, facial plethora, right upper extremity edema, and venous collaterals. When instructed to raise both arms, facial congestion and cyanosis (Pemberton's sign) were observed. Subsequent work-up revealed an anterior mediastinal tumor compressing the superior vena cava (SVC), causing SVCS.
Results
A venogram was immediately performed (Figure 2) which revealed a 70% concentric narrowing at the proximal SVC, with the narrowest diameter being 3.2 mm, a distal SVC diameter of 11.17 mm, and a lesion length of 22.4 mm (Figure 2A). The distal subclavian vein was completely occluded following contrast injection, with contrast stasis along the right upper extremity venous system. A Boston Scientific Over-The-Wire Mustang (0.035") 7.0 mm x 40 mm balloon inflated to 9 atm was employed to pre-dilate the stenosed portion. Following adequate pre-dilation, a Boston Scientific Express LD Vascular 9 mm x 25 mm balloon-expandable stent was placed at the SVC and was inflated at 12 atm for 5 seconds. The final venogram demonstrated a new diameter of 9.7mm with residual stenosis of 10% (Figure 2B). The procedure was well tolerated by the patient with no complications. The patient reported immediate resolution of symptoms post procedure. The rest of the hospital stay was unremarkable. The official biopsy confirmed large cell neuroendocrine tumor. The patient was sent home with dabigatran & clopidogrel. Patient underwent 30 cycles of radiotherapy and 4 cycles of carboplatin-paclitaxel-durvalumab chemotherapy as outpatient. A repeat PET-Scan revealed a decreased in FDG-uptake associated with fibrosis of mediastinal mass. The patient has been declared on clinical remission.
Conclusion
Superior vena cava syndrome is a potentially fatal oncologic emergency that requires prompt diagnosis and treatment to alleviate symptoms of obstruction and avert life-threatening complications. In the era of rapid technological advancement, endovascular stenting has emerged as the first-line treatment of SVC syndrome for both malignant and benign etiologies. This paper aims to update the physicians and cardiologists with the contemporary and evolving therapeutic approach to SVC syndrome.
