Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 643-655
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.643
Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus: A case report
Ji-Lian Wang, Chuan-Ya Xu, Chun-Jing Geng, Lei Liu, Ming-Zhu Zhang, Hua Wang, Ruo-Tao Xiao, Lu Liu, Geng Zhang, Cheng Ni, Xiang-Yang Guo
Ji-Lian Wang, Chuan-Ya Xu, Chun-Jing Geng, Geng Zhang, Xiang-Yang Guo, Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
Lei Liu, Ruo-Tao Xiao, Department of Urology, Peking University Third Hospital, Beijing 100191, China
Ming-Zhu Zhang, Cheng Ni, Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hua Wang, Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
Lu Liu, Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
Author contributions: Wang JL, Ni Cheng, Geng CJ, Liu L (Lei Liu), Wang H, Xiao RT, Liu L (Lu Liu) and Zhang G participated in patient care, data collection and manuscript draft; Ni C, Xu CY, Zhang MZ and Guo XY contributed to data analysis and manuscript revision; all authors have read and approved the final manuscript.
Supported by the Key Research Foundation from Peking University Third Hospital, No. BYSY2017001 and No. BYSYZD2019043; and the National Natural Science Foundation of China, No. 81771146.
Informed consent statement: Written informed consent for publication was obtained from the patient.
Conflict-of-interest statement: The authors report no conflicts of interest in this work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng Ni, MD, Associate Professor, Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. nicheng@cicams.ac.cn
Received: June 13, 2021
Peer-review started: June 13, 2021
First decision: July 16, 2021
Revised: August 1, 2021
Accepted: December 8, 2021
Article in press: December 8, 2021
Published online: January 14, 2022
Abstract
BACKGROUND

Ewing’s sarcoma of the adrenal gland with inferior vena cava (IVC) and right atrium thrombus is extremely rare. Here, we report a case of giant adrenal Ewing’s sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management.

CASE SUMMARY

A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months. Enhanced abdominal computed tomography revealed a large retroperitoneal mass (22 cm in diameter), which may have originated from the right adrenal gland and was closely related to the liver. Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle. After preoperative preparation with cardiopulmonary bypass, sufficient blood products, transesophageal echocardiography and multiple monitoring, tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team. Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously. During transfer of the patient to the intensive care unit (ICU), cardiac arrest occurred without external stimulus. Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min. In the ICU, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were provided to maintain cardiac, liver and kidney function. Histopathologic examination confirmed the diagnosis of Ewing’s sarcoma. After postoperative treatments and rehabilitation, the patient was discharged from the urology ward.

CONCLUSION

An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare, and its anesthesia and perioperative management have not been reported. Thus, this report provides significant insights in the perioperative management of patients with adrenal Ewing’s sarcoma and IVC tumor thrombus. Intraoperative circulation fluctuations and sudden cardiovascular events are the major challenges during surgery. In addition, postoperative treatments including ECMO and CRRT provide essential support in critically ill patients. Moreover, this case report also highlights the importance of multidisciplinary cooperation during treatment of the disease.

Keywords: Ewing’s sarcoma, Anesthesia, Inferior vena cava, Cardiac arrest, Tumor thrombus

Core Tip: An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare, and its anesthesia and perioperative management have not been reported. We report tumor resection and perioperative management in a case of adrenal Ewing’s sarcoma with IVC and right atrium thrombus. After surgery, cardiac arrest occurred and CPR was successfully performed. Following postoperative treatment and rehabilitation, the patient was discharged from the hospital and then survived for more than 17 mo. Therefore, this report provides insights for the perioperative management of adrenal Ewing’s sarcoma with distant vascular extension.