Primary synovial sarcoma of parotid gland with intravenous extension into the heart

We are reporting a case of a 47-year-old male with primary synovial sarcoma of the right parotid gland with tumor thrombus extension in the right internal jugular vein and right atrium. The rarity of this occurrence as documented in the review of the literature provides for uncertainty about proper management. Our case represents a rare occurrence with the unique radiological finding that has implications for management.

ADRENAL METASTASES OF RENAL CELL CARCINOMA WITH INTRAVENOUS TUMOR THROMBI OF THE INFERIOR VENA CAVA (two case repor ts with literature review)

Intrvenous extension is one of the features of neoplastic process and is very characteristic for tumors of the kidneys and adrenal glands. However, reports about the penetration of adrenal metastases into the venous system are extremely rare. We have presented two case reports on intravenous extension of renal cell carcinoma adrenal metastases. One of them for the first time in worldwide literature presents intravenous extension of synchronous bilateral adrenal metastases RCC into inferior vena cava and left renal vein. The patient underwent bilateral adrenalectomy with the use of hormone replacement therapy and targeted therapy with pazopanib. MDCT after 2 and 6 months did not show tumor progression. Lungs metastases are reduced in size or remained unchanged. The patient does not complain. Blood pressure 110/70 mm Hg. Symptoms of Addison's disease are absent. In the second case, there was a metachronic contralateral metastasis of RCC, which penetrated through the right adrenal vein into the subhepatic section of the inferior vena cava. The patient underwent a right-sided adrenalectomy with thrombectomy. After 6 months multiple pulmonary metastases were identified. Pazopanib therapy has initiated. Three months later, tumor progression was revealed. The patient died after 5 months (14 months after surgery) from tumor intoxication. Although these cases are extremely rare (7 cases in the world literature), it is necessary to take into account possibility of presence of venous tumor thrombi with adrenal metastases. The incidence of this phenomenon of RCC is in the second place after hepatocellular carcinoma (15 cases). Organ-sparing surgical technique in these patients is not feasible. Targeted therapy along with hormone replacement therapy was not accompanied by increased side effects or exacerbation of adrenal insufficiency after removal of both adrenal glands.