PMC7363624_01
Preoperative investigations. A and B: EUS image at the time of diagnosis of tumor, and fine needle aspirate showing spindle shaped cells with S-100 staining C: Recent CT image of the tumor (yellow arrow) displacing IVC (white arrow) and sandwiched between IVC and abdominal aorta (arrowhead). D: T2-weighted MR image with intratumoral hyperintensity. E: Increased uptake in FDG-PET scan. F: The cut of resected specimen.
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Endoscopic ultrasonogram (EUS) revealed low echoic mass of size 24*21 mm located behind portal vein (Fig. 1A), and tissue aspirate extracted by 22-gauge needle via duodenum showed the follicular nests of spindle shaped tumor cells in a palisading pattern. The tumor cells positively stained for S-100 (Fig. 1B). IVC, horizontal part of duodenum, right renal artery, right kidney and adrenal gland (Fig. 1C). It was sandwiched between abdominal aorta and the IVC, displacing the later. T2 weighted images and PET CT also showed slight signal uptake (Fig. 1D and E). The tumor doubling time was 653 days. The cut of specimen revealed nonhomogeneous solid tumor with capsule (Fig. 1F).
A. Right renal vein was taped, and right testicular artery was ligated. B. IVC and right renal vein were taped. C. Right renal artery and vein were preserved and inspected for sufficiency of blood flow. D. The dorsal caudal and cranial aspects of tumor was dissected, and tumor was peeled off en bloc.
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The right testicular vein was clipped and divided (Fig. 2A). Likewise, dissection was done on the left side of IVC followed by taping of IVC (Fig. 2B). Right renal artery, which was displaced by the tumor caudally, was isolated from it and the blood flow was inspected with blood flow meter (Fig. 2C). After that, the tumor was separated from IVC, dissected on its posterior aspect and peeled off (Fig. 2D).