Intraluminal superior vena cava metastasis from adenosquamous carcinoma of the duodenum: A case report

Abstract

In 2013, a 76-year-old male with a cardiac pacemaker was diagnosed with adenosquamous carcinoma of the duodenum. Subsequently, a pancreatoduodenectomy and lymph node dissection were performed, and 12 cycles of adjuvant chemotherapy (modified FOLFOX6 regimen), which consisted of fluorouracil, leucovorin and oxaliplatin, were administered via a central venous catheter. At 5 months after the completion of adjuvant chemotherapy, the patient experienced the sudden onset of severe pain at the back right of the ear, edema of the right side of the face and right jugular vein dilatation. Computed tomography (CT) revealed filling defects in the superior vena cava (SVC) and right brachiocephalic vein, indicating catheter-induced venous thrombosis. Although the catheter was removed and anti-coagulation therapy, aspiration of the thrombosis and ballooning dilatation were performed immediately, the patient's symptoms were not ameliorated. Notably, histological examination following thrombus aspiration revealed metastatic cancer cells, and fluorodeoxyglucose-positron emission tomography/CT identified metabolically active nodules in the SVC at locations consistent with the initial duodenal tumors detected by CT and in the first thoracic vertebrae. The tumor thrombus rapidly increased in size and resulted in worsening dyspnea. Subsequently, radiotherapy was performed, followed by chemotherapy, which relieved the systemic symptoms and suppressed the tumor growth. Adenosquamous carcinoma of the duodenum is extremely rare, and to the best of our knowledge, intraluminal SVC metastasis as a result of adenosquamous carcinoma of the duodenum has not been reported previously. The placement of a cardiac pacemaker, central venous catheter and tumor cells possessing high metastatic potential are hypothesized to have contributed to this rare case of metastasis.

ICAM-1: A master regulator of cellular responses in inflammation, injury resolution, and tumorigenesis

“…CTCs (likely in the case of CTC clusters) may become trapped in the post-capillary venules in the lung, spleen, or liver, 169 and upon intraluminal proliferation can give rise to secondary tumors. [170][171][172] CTCs may also hijack mechanisms governing leukocyte recruitment to extravasate from the circulation into the surrounding tissue. In this process, ICAM-1 expressed by ECs will be a key regulatory player.…”

Superior vena cava syndrome as a paraneoplastic manifestation of soft tissue sarcoma

“…Santra et al reported paraneoplastic thrombus formation in SVC due to lung cancer. 5 Moreover, paraneoplastic causes of SVC syndrome due to thrombosis have been reported in association with renal cell carcinoma, 6 ovarian cancer 7 and Richter syndrome. 8 Obstruction of the SVC can also be due to intraluminal metastasis without thrombus formation.…”

“… 13 Other nonspecific methods include head elevation, mild diuresis and corticosteroids to decrease swelling and dyspnea. When thrombosis is the cause of SVC syndrome, thrombolysis 1 and/or anticoagulation 1 , 2 , 3 , 4 , 5 may be indicated. Our patient received anticoagulation and chemotherapy.…”

Intestinal obstruction caused by primary adenosquamous cell carcinoma of the small intestine: A case report and review of the literature

“…Due to its rarity, the clinicopathological characteristics and survival outcomes of intestinal ASCC have not been clearly determined. The previous reports are summarized in Table I ( [13][14][15][16][17][18][19][20]. Almost all patients had abdominal pain as a chief complaint, and their median age was 76 years (range, 55-80 years).…”