Cor Vasa 2020, 62(5):492-494 | DOI: 10.33678/cor.2020.005

Giant Germ Tumor Retroperitoneal Lymphadenopathy Encapsulating the Infrarenal Aorta and Inferior Vena Cava: Case Report

Róbert Novotný^a, Libor Janoušek^a,c, Květoslav Lipar^a, Jaroslav Chlupáč^a,b, Jakub Křístek^a,d, Michal Kudla^a,b, Jiří Froněk^a,b,c

^a Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague

^b First Faculty of Medicine, Charles University, Prague

^c Second Faculty of Medicine, Charles University, Prague

^d Department of Anatomy, Second Faculty of Medicine, Charles University, Prague

Introduction: Testicular germ cell tumour (GCT) is the most common malignant solid tumour among Caucasian men with the highest incidence between 15-45 years. GCT had shown an increasing incidence in the past 30 years.

Method: The procedure was performed through the midline laparotomy. Massive retroperitoneal lymphadenopathy (RL) was found in the abdomen. The infrarenal aorta (IA) and inferior vena cava (IVC) were carefully dissected and entirely freed from the RL. Part of the left renal vein (LRV) showed suspicious infiltration by the RL. Therefore we performed a partial LRV resection. The residual LRV was short, the reanastomosing to the IVC was not possible. We reanastomosed the residual LRV to the splenic vein. Due to the large size of the resected RL combined with a close encounter with IA and IVC, surgical swabs were placed into the abdomen for high risk of postoperative bleeding. The second look was performed 24 hours after the procedure, and the midline laparotomy was closed in a standard manner.

Results: Postoperative period was uneventful. The patient was discharged on the 8th postoperative day with good renal functions and good left kidney perfusion and drainage on Doppler's ultrasonography.

Conclusion: A multidisciplinary approach combining chemotherapy and surgical intervention is needed in patients with GCT and large retroperitoneal masses in order to significantly increase the curative success.

Keywords: Germinal, Lymphadenopathy, Metastasis, Resection, Retroperitoneal, Teratoma, Tumour

Received: August 27, 2019; Revised: August 27, 2019; Accepted: January 16, 2020; Published: November 1, 2020  Show citation