The management of inferior vena cava obstruction complicating metastatic germ cell tumors

Cancer. 1999 Feb 15;85(4):912-8.


Background: Inferior vena cava obstruction (IVCO) is a poorly characterized complication of metastatic germ cell tumor (GCT). The authors identified 31 cases to describe the clinical features, radiologic findings, complications, and treatment of this clinical entity.

Methods: Patients with GCT and IVCO were identified from case records of a GCT database. The records of 333 male patients with metastatic GCT (27% with seminoma and 73% with nonseminomatous GCTs) were screened for either clinical or computed tomography (CT) scan evidence of inferior vena cava compression or involvement.

Results: Thirty-one patients were identified (9.3% of patients with metastatic GCT). Common presenting symptoms were leg swelling and dilated abdominal wall veins. Approximately 29% of patients had thromboembolic complications and there was a single case of fatal pulmonary embolism. Nine patients had no clinical features at presentation but either had CT scan evidence of IVCO or developed symptoms during treatment. Right-sided testicular primary tumors were associated more frequently with IVCO compared with left-sided primary tumors (14% vs. 4% of cases of metastatic GCT, respectively). All patients had an abdominal mass measuring > 5 cm in maximum transverse dimension.

Conclusions: The authors recommend careful clinical and radiologic evaluation for the presence of IVCO in cases of bulky metastatic GCT. A high index of suspicion must accompany the evaluation of a patient with a right-sided primary testicular tumor and a paracaval abdominal mass measuring > 5 cm in maximum transverse dimension. When IVCO is identified, prophylactic anticoagulation is recommended.

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Carcinoma, Embryonal / complications
  • Carcinoma, Embryonal / secondary
  • Choriocarcinoma / complications
  • Choriocarcinoma / secondary
  • Constriction, Pathologic / diagnostic imaging
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / therapy
  • Germinoma / complications*
  • Germinoma / diagnostic imaging
  • Germinoma / secondary
  • Humans
  • Male
  • Peripheral Vascular Diseases / diagnostic imaging
  • Peripheral Vascular Diseases / etiology*
  • Peripheral Vascular Diseases / therapy
  • Prognosis
  • Radiography
  • Retroperitoneal Neoplasms / complications*
  • Retroperitoneal Neoplasms / diagnostic imaging
  • Retroperitoneal Neoplasms / pathology
  • Retroperitoneal Neoplasms / secondary
  • Seminoma / complications
  • Seminoma / secondary
  • Teratocarcinoma / complications
  • Teratocarcinoma / secondary
  • Testicular Neoplasms / complications*
  • Testicular Neoplasms / diagnostic imaging
  • Testicular Neoplasms / pathology
  • Vena Cava, Inferior* / diagnostic imaging


  • Anticoagulants