Superior vena cava syndrome due to metastasis from urothelial cancer: A case report and literature review
A 59-year-old man presented with dyspnea, face and neck edema, strangled feeling, cough and fatigue in April 2008. Symptoms rapidly advanced over the course of 1 week. He was known case of UC for which he underwent transurethral resection for bladder tumor (TURBT) (the size was 7 cm, left wall, UC, G2 > G1, pTa) in April 2005. In addition, 2 weeks later left nephroureterectomy had been performed for the left ureter and renal-pelvis cancer. The entire mucosa of the ureter and renal-pelvis were replaced by papillary tumor [] and histological examination showed UC, G2>>G3, pT2, ly0, and v0. Because of high grade invasive cancer, two courses of adjuvant chemotherapy had been administered using methotrexate, vinblastine, doxorubicin hydrochloride, and cisplatin (MVAC therapy). In February 2006, multiple bladder tumors (9 papillary tumors, size was 5 to 15 mm) had recurred and TURBT was performed (UC, G2, pTa). No metastatic lesions were found until the second admission. After TURBT the patient came the hospital twice for the convenience of the patients, and he was not followed for 1 year and presented again with SVC symptoms. The face, neck, and right upper limb were edematous and varicosis of the right jugular vein was apparent. Computer tomography (CT) scan revealed multiple lung masses involving a 5 cm tumor in the right upper lung field and multiple lymph nodes in the mediastinum []. Massive nodes constricted the upper part of the SVC and merging section of bilateral brachiocephalic veins. Bone scintigraphy revealed a hot spot in the forehead bone. Glucocorticoid (bethamethasone 16 mg/day) was administered and radiotherapy was started on the second day of admission. Twenty days later CT-guided biopsy was performed and metastasis of UC was diagnosed histopathologically []. A total 40 Gy of radiation proved ineffective and edema of the face and upper limbs continued. A modified intravenous anti-cancer chemotherapy was initiated with paclitaxel at 60 mg/m2 on days 1 and 8, gemcitabine at 1000 mg/m2 on days 1 and 8, and cisplatin 70 mg/m2 on day 2.[] Facial edema and dyspnea temporarily worsened with fluid infusion, but symptoms improved and the size of tumors decreased after one course of this chemotherapy. After three courses of the chemotherapy, most lung metastases had vanished and the main lung tumor had decreased to a diameter of 2 cm. Lymph nodes became reduced in size, but compression of the SVC remained. However, collateral circulations around the compression of the SVC and the dorsal chest wall developed, improving SVC syndrome. About ten months later patient died due to cerebral bleeding around the forehead metastasis.