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Oncology
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Case Report
Abstract
Background: In superior vena cava syndrome (SVCS), the superior vena cava becomes mechanically obstructed by venous thrombus formation or by compression caused by intrathoracic tumors. SVCS is most common in men over 45 years of age; 22.5% of patients with SVCS have stage IV lung cancer or lymphoma. SVCS may occur secondary to extrathoracic tumors (testicular, ovarian, kidney, intestinal).
Case presentation: Male (24 years old) with a history of cancer in his maternal grandmother; denied drug addiction. Factory worker who denied being in direct contact with any chemicals and/or toxins. He reported non-productive cough; paroxysmal unilateral left facial edema without time-of-day predominance; paresthesias, edema of the left upper thoracic limb and distension of the thoracic veins with three months of evolution; well-ventilated lung fields, tachycardic heart sounds, without murmurs. The symptoms increased after the third dose of the COVID-19 vaccine was applied. Hypertension was diagnosed. Sustained supraventricular tachycardia (152 bpm) and displacement of the long-axis parasternal window were observed due to the presence of a mass on the echocardiogram. The mass was observed in the short-axis parasternal window, apical (three, four, and five chambers), and subxiphoid. Chest X-ray identified the mediastinal mass and chest CT located the retrosternal mass (7 cm long), although sagittal reconstruction indicated 9 cm. A sample was obtained by Chamberlain procedure and analyzed with the immunohistochemical panel. A malignant neoplasm of germ cell origin was observed, basophilic cells with round to oval, pleomorphic and hyperchromatic nuclei and organized in a solid pattern, infiltrating the striated muscle cells and adjacent adipose tissue. The reaction was positive for PAN-Ck clone AE1/AE3 and PCK26 (cytoplasm), intense and focal; vimentin clone V9 (cytoplasm), intense and diffuse; CD45 (LCA) clone RP2/18 (membrane), intense in lymphocytes; CD3 clone 2GV6 (cytoplasm-membrane): intense in T lymphocytes; CD20 clone L26 (cytoplasm): intense in B lymphocytes; SALL4 clone 6E3 (nucleus), intense and diffuse; KI-67 clone 30-9E (nuclear), positive in 70%. The tumor causing the SVCS was germinal and was classified as T4 (tumor >7 cm that invaded the mediastinum, heart, and part of the superior vena cava); N0, since there was no involvement of regional lymph nodes and M0, since no distant metastasis was observed. Therefore, T4, N0, M0 = Stage IIIA). The patient underwent prophylactic chemotherapy in hematology (two doses of doxorubicin, vinblastine, dacarbazine, and bleomycin). Then, the regimen in oncology was four doses of bleomycin, etoposide, and cisplatin. Then, filgrastim was administered.
Conclusions: SVCS was due to a malignant germ cell tumor in the lung. Two chemotherapy regimens were applied, one prophylactic in hematology and another in oncology when the tumor was diagnosed. When the tumor was reduced in size and metastasis was ruled out, total or partial resection was considered. The case is relevant in identifying SVCS associated with a germ cell tumor in a 24-year-old young man. The patient 'attributed' his symptoms to the COVID vaccine, although he experienced a more serious underlying disease that was not diagnosed.
Recommended Citation
Lara Duck, Manlio F.; Mayek Pérez, Netzahualcoyotl; and Rosales Martínez, Juan, "Superior vena cava syndrome due to germ cell tumor in a young adult: case report" (2025). Research Symposium. 96.
https://scholarworks.utrgv.edu/somrs/2025/posters/96
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Cardiology Commons, Diagnosis Commons, Hematology Commons, Neoplasms Commons, Oncology Commons, Therapeutics Commons
Superior vena cava syndrome due to germ cell tumor in a young adult: case report
Background: In superior vena cava syndrome (SVCS), the superior vena cava becomes mechanically obstructed by venous thrombus formation or by compression caused by intrathoracic tumors. SVCS is most common in men over 45 years of age; 22.5% of patients with SVCS have stage IV lung cancer or lymphoma. SVCS may occur secondary to extrathoracic tumors (testicular, ovarian, kidney, intestinal).
Case presentation: Male (24 years old) with a history of cancer in his maternal grandmother; denied drug addiction. Factory worker who denied being in direct contact with any chemicals and/or toxins. He reported non-productive cough; paroxysmal unilateral left facial edema without time-of-day predominance; paresthesias, edema of the left upper thoracic limb and distension of the thoracic veins with three months of evolution; well-ventilated lung fields, tachycardic heart sounds, without murmurs. The symptoms increased after the third dose of the COVID-19 vaccine was applied. Hypertension was diagnosed. Sustained supraventricular tachycardia (152 bpm) and displacement of the long-axis parasternal window were observed due to the presence of a mass on the echocardiogram. The mass was observed in the short-axis parasternal window, apical (three, four, and five chambers), and subxiphoid. Chest X-ray identified the mediastinal mass and chest CT located the retrosternal mass (7 cm long), although sagittal reconstruction indicated 9 cm. A sample was obtained by Chamberlain procedure and analyzed with the immunohistochemical panel. A malignant neoplasm of germ cell origin was observed, basophilic cells with round to oval, pleomorphic and hyperchromatic nuclei and organized in a solid pattern, infiltrating the striated muscle cells and adjacent adipose tissue. The reaction was positive for PAN-Ck clone AE1/AE3 and PCK26 (cytoplasm), intense and focal; vimentin clone V9 (cytoplasm), intense and diffuse; CD45 (LCA) clone RP2/18 (membrane), intense in lymphocytes; CD3 clone 2GV6 (cytoplasm-membrane): intense in T lymphocytes; CD20 clone L26 (cytoplasm): intense in B lymphocytes; SALL4 clone 6E3 (nucleus), intense and diffuse; KI-67 clone 30-9E (nuclear), positive in 70%. The tumor causing the SVCS was germinal and was classified as T4 (tumor >7 cm that invaded the mediastinum, heart, and part of the superior vena cava); N0, since there was no involvement of regional lymph nodes and M0, since no distant metastasis was observed. Therefore, T4, N0, M0 = Stage IIIA). The patient underwent prophylactic chemotherapy in hematology (two doses of doxorubicin, vinblastine, dacarbazine, and bleomycin). Then, the regimen in oncology was four doses of bleomycin, etoposide, and cisplatin. Then, filgrastim was administered.
Conclusions: SVCS was due to a malignant germ cell tumor in the lung. Two chemotherapy regimens were applied, one prophylactic in hematology and another in oncology when the tumor was diagnosed. When the tumor was reduced in size and metastasis was ruled out, total or partial resection was considered. The case is relevant in identifying SVCS associated with a germ cell tumor in a 24-year-old young man. The patient 'attributed' his symptoms to the COVID vaccine, although he experienced a more serious underlying disease that was not diagnosed.
