Leiomyosarcoma of the right gonadal vein; A case report with review of literature

McConnell’s Sign in a Patient with Amniotic Fluid Embolism and Severe Right Ventricular Dysfunction

Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein

Renal cell carcinoma (RCC) with invasion into the renal vein is well described; however, invasion into the gonadal vein is a rare event with less than five cases reported in the literature. RCC occasionally presents with metastasis to the ovaries or the fallopian tubes, although this is also a rare occurrence. We present a case of locally advanced left RCC with direct extension into the ipsilateral gonadal vein with extension into the bilateral ovaries and uterus, which has not been previously described. Computed tomography (CT) in a 72-year-old female with a 35-pound weight loss indicated the presence of a 16-cm left renal mass with caudal tumor extension through the left gonadal vein and regional lymph-adenopathy. There was no evidence of distant metastasis, and she underwent an open left radical nephrectomy. Intraoperatively, she was found to have direct extension of the tumor through the left gonadal vein into the uterus, bilateral ovaries, and the left fallopian tube. All visible dis-ease was resected, and retroperitoneal and pelvic lymphadenectomy were performed. The patient had an uneventful hospital course. Pathology revealed clear cell RCC, Fuhrman grade 3. The final pathologic stage was pT4N1M1. The patient was ultimately noted to have pulmonary metastasis and was treated with immunotherapy with no evidence of disease progression.

Renal cell carcinoma (RCC) with invasion into the renal vein is well described; however, invasion into the gonadal vein is a rare event with less than five cases reported in the literature. RCC occasionally presents with metastasis to the ovaries or the fallopian tubes, although this is also a rare occurrence. We present a case of locally advanced left RCC with direct extension into the ipsilateral gonadal vein with extension into the bilateral ovaries and uterus, which has not been previously described. Computed tomography (CT) in a 72-year-old female with a 35-pound weight loss indicated the presence of a 16-cm left renal mass with caudal tumor extension through the left gonadal vein and regional lymphadenopathy. There was no evidence of distant metastasis, and she underwent an open left radical nephrectomy. Intraoperatively, she was found to have direct extension of the tumor through the left gonadal vein into the uterus, bilateral ovaries, and the left fallopian tube. All visible disease was resected, and retroperitoneal and pelvic lymphadenectomy were performed. The patient had an uneventful hospital course. Pathology revealed clear cell RCC, Fuhrman grade 3. The final pathologic stage was pT4N1M1. The patient was ultimately noted to have pulmonary metastasis and was treated with immunotherapy with no evidence of disease progression.

The kidneys are a pair of retroperitoneal organs located at the level of the L1, L2, and L3 positions. At the level of the tenth rib, the superior portion of the kidney is located within the lower thoracic cage. Due to the existence of the liver, the right kidney is lower than the left kidney. The adult kidney weights about 150 gm. Right kidney is broad and short and left kidney is narrow and long. Right renal artery is longer than the left renal artery and right renal vein is shorter than the left renal vein. Renal arteries are end arteries while veins anastomose freely. Left gonadal vein and left suprarenal vein (adrenal vein) drain into the left renal vein. Right suprarenal vein and gonadal vein drain into inferior vena cava. Both the ureters are draining from the kidneys behind the renal artery. From anterior to posterior we get renal vein, renal artery and ureter. In this case report we found pair of kidney with renal vein and renal artery. Right renal artery is longer than the left renal artery and left renal vein is longer than the right renal vein. We can see the posterior aspect of inferior vena cava.Left gonadal vein and left suprarenal vein (adrenal vein) are draining into the left renal vein. Right suprarenal vein and gonadal vein are draining into inferior vena cava. Both the ureters are draining from lower end behind the renal artery. From anterior to posterior we get renal artery, renal vein and ureter. Here we are getting duplication of ureter in the left side. On right side, there three accessory renal arteries, one to the inferior pole and two to the hilum behind the main renal artery of the kidney. On the left side, there are two renal arteries one going to the hilum behind the main renal artery and one going to the inferior pole of the kidney. On right side ureter is draining behind the renal vein. The duplex ureter drains behind the renal vein on the left side. The left suprarenal vein is twisted here, and the gland is also visible farther down because the venacava is turned down, revealing its posterior aspect, and no venous tributaries flow from it.

Renal nutcracker syndrome is a rare phenomenon that often causes various disability symptoms. The treatment protocol has been explored for a long time, but no consensus has been reached. Here, we report the case of a 19-year-old male suffering with nutcracker syndrome, including left-sided flank pain and intermittent gross hematuria. The patient was diagnosed with renal nutcracker syndrome, and the pressure gradient between the left renal vein and inferior vena cava was >5 mm Hg. The patient underwentrobotic-assisted combined transposition of left renal vein and gonadal vein. Flank pain and gross hematuria ceased spontaneously after surgery without occurrence. Robotic-assisted combined transposition of the left renal vein and gonadal vein is a safe and promising option for this condition.

Objective: The objective of this presentation is to share our experiences with an unusual repair of a defective graft renal vein using an own gonadal vein, which occurred iatrogenically during a laparoscopic donor nephrectomy. Case Report: A 35-year-old man with situs inversus totalis was referred to our clinic for a living-related renal transplant with a diagnosis of end-stage renal disease. The donor was 66-year-old mother of the patient. Laparoscopic left donor nephrectomy was planned for his mother . At the end of laparascopic disection renal vein tear occurred during the renal extraction. Without any intervention renal extraction was performed to maintain the patency of renal allograft and to stabilize the donor. Partial hemorrhage from renal vein was brought under control. Donor nephrectomy was completed with a defective remaining segment of renal vein. We decided to repair with gonadal vein patch ın the unexpected renal vein injury. Patch from tearing part of renal vein with short gonadal vein repairment was performed. After repairment of graft renal vein, anastomosis to external iliac vein was performed. The trans-plant procedure was completed successfully. The kidney functioned immediately. Doppler ultrasound revealed that perfusion of the kidney was normal. The postoperative creatinine levels of recipient were in the normal ranges. Daily urine output was normal. Conclusion: Repairment of a defective graft renal vein by using own gonadal vein seems to be a simple, safe, and reliable method. This technique provides an alternative approach for the reconstruction of vessels in living-donor kidney transplants.

IntroductionIsolated acute traumatic renal vein occlusion is rare. As both kidneys have limited capsular and peripelvic vein collaterals, acute renal vein occlusion could lead to renal infarction. However, the left renal vein has potential collateral pathways through the gonadal vein. Presentation of caseA 56-year-old woman was transferred to our trauma center after a pedestrian accident. Computed Tomography (CT) with contrast enhancement showed that no delineation of left renal vein with adjacent retroperitoneal hematoma around renal vessels, but left renal venous flow was being drained through left gonadal vein, therefore, left kidney was not congested. Her serum creatinine concentration was normal. We elected to treat her left renal vein occlusion conservatively because of the collateral pathway into the gonadal vein. DiscussionCollateral pathway of the left renal venous drainage may be well known to urologists or vascular surgeons, but may be unfamiliar to trauma surgeons. Therefore, trauma surgeon’s attempts for revascularization of thrombosed left renal vein may lead to massive bleeding or nephrectomy. ConclusionAcute left renal vein occlusion close to the inferior vena cava can result in temporary venous hypertension and congestion followed by complete or nearly complete return of function as collateral veins enlarge. If the gonadal vein is patent, left renal vein occlusion could be treated conservatively.

A previously healthy 30-year-old man with a symptomatic varicocele underwent gonadal vein embolization using nickel vascular plugs. He developed a painful hypersensitivity to his nickel plugs and elected to pursue laparoscopic excision and proximal gonadal vein ligation. In the operating room, the gonadal vein was isolated from the ureter, and ligated proximal to the cephalad plug and distal to the caudal coil. His pain is completely resolved 5 months after surgery. Metal allergies are well documented in orthopedics and cardiology implants, but there are a limited number of case reports of metal allergies after varicocele embolization. Interestingly, nickel is the most common type of metal hypersensitivity.

EP980 Gonadal vein graft after retroaortic left renal vein injury during paraaortic lymphadenectomy: a case report

The gonadal veins, responsible for draining from the paired gonads (testes in males and ovaries in females), exhibit variations in anatomy. Traditionally, the right gonadal vein directs its drainage into the inferior vena cava, while the left gonadal vein typically connects to the left renal vein. However, in the case of a 45-year-old woman diagnosed with a non-functional right kidney who underwent a right nephrectomy, an intraoperative observation revealed an unusual configuration: the right gonadal vein (ovarian) was found to drain directly into the right renal vein instead of its usual route into the inferior vena cava. This case report aims to elucidate this anomalous finding and provide a literature review on the prevalence of such anomalies in the existing research. This case report aims to raise awareness about the atypical drainage patterns of gonadal veins and underscore the importance of meticulous dissection of hilar renal vessels.

Emergent nonconventional mesosystemic shunt for diffuse portomesenteric thrombosis: Sparing patients from liver/multivisceral transplantation

Background Venous leiomyosarcoma is a mesenchymal tumour that represents 5-7% of soft tissue sarcomas. It originates in the smooth muscle cells of the vessel wall and is frequently located in the inferior vena cava. Primary leiomyosarcomas of the gonadal vein are rare, with only 10 cases reported in the literature. Case report We present the case of a 51-year-old woman diagnosed with a right retroperitoneal mass by computed tomography (CT). The differential diagnosis was between a neurogenic tumour and a mesodermic tumour. The tumour was dissected from the vena cava and right ureter by laparoscopy without performing resection en bloc. Histologic examination of the surgical specimen showed a high-grade leiomyosarcoma of the right gonadal vein. The postoperative course was uneventful. Three cycles of chemotherapy with epirubicin-ifosfamide were performed. Discussion and conclusions Venous leiomyosarcoma is an aggressive tumour, and prognosis is poor due to haematogenous spread. No chemotherapy or radiotherapy has yet proven effective in improving survival, and complete surgical excision is currently considered to offer the best chance of cure. Despite the more conservative treatment approach used in the present case, the patient is alive three years after surgery and has a good quality of life. Although it was not used in this patient, the standard procedure for optimal survival is resection en bloc.

A Novel Technique for Reconstruction of Multiple Renal Arteries in Live Donor Kidney Transplantation: A Case Report and Literature Review

Testicular Pain Following Laparoscopic Renal Surgery