PMC4727094_01
Histopathological examination of the tumors. (A) HE staining (magnification, x100), and (B) E-cadherin and (C) beta-catenin immunostaining (magnification, x400) in the primary tumors. (D) HE staining (magnification, x200), and (E) E-cadherin and (F) beta-catenin immunostaining (magnification, x400) in the intraluminal superior vena cava metastasis. HE, hematoxylin and eosin.
ol-11-01-0605-g00.jpg
PMC4727094_01_ol-11-01-0605-g00.jpg
f1-ol-0-0-3938
TNM Classification of Malignant Tumours ] (Fig. 1A). The tumor was mainly composed of three types of tissue: i) Adenocarcinoma proliferating in a glandular pattern, ii) squamous cell carcinoma with apparent squamous differentiation and iii) poorly-differentiated carcinoma, which exhibited no features of adenocarcinoma or squamous cell carcinoma. By contrast, the poorly-differentiated carcinoma components were negative for E-cadherin and beta-catenin (Fig. 1B and C). Pathological examination of the thrombus aspiration identified metastatic carcinoma, which exhibited similar features to that observed in the poorly-differentiated component of the primary tumor identified in the duodenum (Fig. 1D). Immunohistochemistry revealed that the tumor cells were negative for E-cadherin (Fig. 1E) and beta-catenin (Fig. 1F).
CT and FDG-PET/CT of the chest. (A) CT scan and (B) FDG-PET/CT performed following the sudden onset of symptoms in July 2014. (C) CT scan performed 3 weeks after the appearance of symptoms. (D) CT scan following two cycles of chemotherapy. CT, computed tomography; FDG-PET, fluorodeoxyglucose-positron emission tomography.
ol-11-01-0605-g01.jpg
PMC4727094_01_ol-11-01-0605-g01.jpg
f2-ol-0-0-3938
Enhanced CT revealed filling defects extending from the SVC to the right brachiocephalic vein, indicating catheter-induced venous thrombosis (Fig. 2A). FDG-PET/CT revealed metabolically active nodules in the SVC at locations identical to those of the tumors identified on CT (Fig. 2B) and in the first thoracic vertebrae. SVC extending to the right atrium (Fig. 2C), however, no pulmonary emboli were identified. Surgical resection of the tumor thrombus was attempted, however, surgery was terminated due to the patient's general condition and the identification of distant metastases. A CT scan performed after two cycles of chemotherapy (November 2014) revealed a significant reduction of the tumor thrombus in the SVC (Fig. 2D).