Superior vena cava (SVC) reconstruction using autologous tissue in two cases of differentiated thyroid carcinoma presenting with SVC syndrome

Yasushi Rino,Nobuyasu Suganuma,Shohei Hirakawa,Tetsukan Woo,Kiyotaka Imoto,Hiromasa Arai,Nobuyuki Wada,Keiichi Uchida,Hideyuki Iwaki,Munetaka Masuda,Norio Yukawa,Katsuhiko Masudo

doi:10.1186/1477-7819-7-75

Abstract

Herein, we report two extremely rare cases of differentiated thyroid carcinoma (DTC) with extended tumor thrombus or mediastinum lymph node metastasis (LNM) involving the superior vena cava (SVC), causing SVC syndrome. Both of these patients were successfully treated with radical resection and reconstruction of the SVC using autologous tissue instead of an expanded polytetrafluoroethylene (ePTFE) graft. The left brachiocephalic vein was used to reconstruct the SVC in a papillary thyroid carcinoma patient with mediastinum LNM and a pericardial patch was used in a follicular thyroid carcinoma patient with tumor thrombus. Our search of the English-language literature found sporadic reports of SVC resection with reconstruction by vascular graft (ePTFE), interposed between the brachiocephalic vein and the right atrium. However, SVC reconstruction using autologous tissue in thyroid carcinoma has not been reported to date. To our knowledge, this is the first report describing such an unusual technique in DTC patients.

Highlights

Superior vena cava (SVC) syndrome is extremely rare in patients with differentiated thyroid carcinoma (DTC)
Our report is the first to use autologous graft as an alternative to the expanded polytetrafluoroethylene (ePTFE) graft that has generally been used for superior vena cava (SVC) reconstruction in DTC patients
Yamagami et al reported a very rare case presenting with huge tumor thrombus extending to the atrium that was effectively treated with tumor thrombectomy alone, without harvesting all of the associated great veins [17]

Summary

Background

Superior vena cava (SVC) syndrome is extremely rare in patients with differentiated thyroid carcinoma (DTC). Vascular reconstruction was performed with the use of the already resected left brachiocephalic vein as autologous tissue (Fig. 2D) This autograft was placed between the distal site of the right brachiocephalic vein and the proximal site of the SVC. The patient initially underwent total thyroidectomy with ipsilateral MND for primary FTC with cervical lymphadenopathy at another institution This patient initially presented with tumor thrombus in the left internal jugular vein via the brachiocephalic vein to the upper part of the SVC. The prognoses in such cases were principally unsatisfactory. Our report is the first to use autologous graft as an alternative to the ePTFE graft that has generally been used for SVC reconstruction in DTC patients

Discussion

Conclusion