Inferior Vena Cava Prosthetic Replacement in a Patient With Horseshoe Kidney and Metastatic Testicular Tumor

Technical Considerations and Review of the Literature

Pietro Rispoli; Paolo Destefanis; Paolo Garneri; Gianfranco Varetto; Beatrice Lillaz; Claudio Castagno; Patrizia Lista; Libero Ciuffreda; Dario Fontana

Disclosures

BMC Urol. 2014;14(40) 

In This Article

Background

Seminomatous and non-seminomatous Germ Cell Tumors (GCT) of the testis are a rare cancer, with an estimated incidence of 56.3 per million white males and 10 per million black males in the United States. The annual incidence of seminomatous GCT is about 32 cases per million and that of non-seminomatous GCT about 27 cases per million.[1] The American Cancer Society estimates 8,820 new cases of testicular cancer will be diagnosed in the United States in 2014 (http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-key-statistics).

Testicular cancer is the most frequent type of testicular cancer in males between 20 and 35 years of age; the 5-year survival rate of seminomatous GCT is 72–80% and that of non-seminomatous GCT is 48–92% depending on prognostic class.[2] The factors that have contributed most to improving survival are accurate tumor staging at diagnosis and appropriate early treatment combining chemotherapy, radiotherapy (in seminomatous GCT), surgery, and careful follow-up. With an aggressive multimodality approach combining the use of cisplatin chemotherapy and surgery, survival rates have improved to 65–85% in patients with poor prognosis, depending on initial extension of disease.[3,4]

Surgery with either post-chemotherapy lymph node dissection or residual tumor resection has become a mainstay in the treatment of non-seminomatous GCT presenting one or more residual masses after chemotherapy. As post-chemotherapy surgery poses particular challenges and often requires ad hoc vascular intervention, e.g., vena cava or aortic graft replacement, patients should be referred to a specialized surgery center with expertise in hepatic resection, vessel replacement, spinal neurosurgery, and thoracic surgery. The benefit to patients treated at such interdisciplinary centers is a significant reduction in perioperative mortality from 6 to 0.8%[5] and local recurrence from 16 to 3% and an overall higher rate of complete resection when treated by a urologic surgeon.[6]

The concurrent presentation of non-seminomatous GCT with retroperitoneal metastasis involving the inferior vena cava and horseshoe kidney, a congenital disorder, is a rare event that further complicates surgical treatment of the tumor. To our knowledge, this is the first such case to be reported.

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