Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin

• Published in: BMC surgery Vol. 20; no. 1; p. 272
• Main Authors: Hulova, S, Aziri, R, Vulev, I, Palacka, P, Kolnikova, G, Rejlekova, K, Chovanec, M, Mardiak, J, Pindak, D, Mego, M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.11.2020; BioMed Central; BMC
• Subjects: Abdomen; Advanced testicular cancer; Angiography; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Aorta; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - pathology; Aorta, Abdominal - surgery; Aortic rupture; Aortic Rupture - diagnostic imaging; Aortic Rupture - etiology; Aortic Rupture - pathology; Aortic Rupture - surgery; Biomarkers; Bleomycin; Bleomycin - administration & dosage; Blood flow; Blood vessels; Cancer; Cancer diagnosis; Cancer metastasis; Cancer therapies; Cardiovascular system; Case Report; Chemotherapy; Cisplatin; Cisplatin - administration & dosage; Clopidogrel; Complications; Computed tomography; Computed Tomography Angiography; Coronary vessels; Disease; Dissection; Endovascular Procedures - methods; Endovascular repair; Etoposide; Etoposide - administration & dosage; Extravasation; Health services; Hemorrhage; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - surgery; Humans; Iliac Vein; Lymph Node Excision; Lymph nodes; Male; Medical prognosis; Metastases; Middle Aged; Molecular weight; Neoplasms, Germ Cell and Embryonal - diagnostic imaging; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - secondary; Neoplasms, Germ Cell and Embryonal - surgery; Orchiectomy; Ostomy; Patients; Prognosis; Prostheses; Retroperitoneal Neoplasms - diagnostic imaging; Retroperitoneal Neoplasms - drug therapy; Retroperitoneal Neoplasms - secondary; Retroperitoneal Neoplasms - surgery; Retroperitoneal tumor; Rupture; Rupturing; Surgery; Testes; Testicular cancer; Testicular Neoplasms - diagnostic imaging; Testicular Neoplasms - drug therapy; Testicular Neoplasms - pathology; Testicular Neoplasms - surgery; Thromboembolism; Thrombosis; Tumors; Ultrasonic imaging; Vascular Neoplasms - diagnostic imaging; Vascular Neoplasms - drug therapy; Vascular Neoplasms - secondary; Vascular Neoplasms - surgery; Veins; Veins & arteries; Vena Cava, Inferior - surgery; Venous Thrombosis - surgery; Case report; Retroperitoneal tumor; Advanced testicular cancer; Aortic rupture; Endovascular repair
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-020-00933-2

Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein. Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta. Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.