腎細胞癌の甲状腺転移とそれに伴う静脈内腫瘍塞栓に対しTransmanubrial Osteomuscular Sparing Approachで静脈再建を施行した1例

Abstract

Renal cell carcinoma (RCC) is known to metastasize frequently to every organ of the body, but metastasis to the thyroid gland is rare. We report a case of metastasis of RCC to the thyroid gland which caused a thrombus in the cervical vein. The patient was a 73-year-old man who had undergone right nephrectomy for renal cancer 18 years ago. The CT scan showed a tumor in the left lobe of the thyroid gland, a tumor embolus from the left internal jugular vein to the subclavian vein, and multiple lung nodules. As the thyroid tumor and embolus in the vein tumor showed the feature of contrast stain at the early phase and washout in the late phase on dynamic CT images, metastatic RCC was highly suspected. Surgery was performed to prevent the tumor from spreading and narrowing the airway. Left thyroid lobectomy with ipsilateral neck dissection, removal of tumor embolus in the veins, and reconstruction of the left subclavian vein were employed. The transmanubrial osteomuscular sparing approach was selected and carried out in cooperation with the Department of Respiratory and Cardiovascular Surgery. Although the patient temporarily had a postoperative infection at the surgical site of the sternum, treatment with an immune checkpoint inhibitor could be started three months after surgery.