Síndrome de vena cava superior y carcinoma insular de tiroides: el stent como alternativa terapéutica paliativa

The superior vena cava syndrome (SVCS) is a uncommon complication of thyroid cancers. It is produced as consequence of the mediastinal spread of the tumor or by intravascularr invasion with thrombosis. We describe a caseof insular thyroid carcinoma with an SVCS solved by putting an intravenous stent. The patient was a 73 year old male that consulted by aphonia and presence of a tumor in the right side of the neck of two months of evolution. The PAAF of thyroid suggested the diagnostic of "follicular tumor". A total thyroidectomy was performed on the patient and the sample histological study revealed the existence of a insular carcinoma. An ablative dosis of 1 3 1 I was adminestered to him. One year after the patient developed the SVCS. A TAC detected a tumoral relapses consistent with clinical syntoms, and was confirmed by a high level of Tg (with TgAntibodies -). As the patient showed a light response to radiotherapy (52Gy), a thoracic flebografy was realized demostrating an extense uper cave venous obstruction. After having accomplished an angioplastia a long stent (20 mm wide) was putt into the uper cave vein that was followed by a fast clinical and radiological improvement. A new flebgraphy practiced three month later showed a rapid venous flux throught the stent, and near totall disappereance of collateral circulation on thorax wall and mediastine.