1, case summary patient, male, 53 years old, retired, engaged in waterproof construction work for 12 years. Previous history of diabetes mellitus for more than 15 years, now menthol insulin 30R 13 IU in the morning and 10 IU in the evening subcutaneously, blood glucose control at about 8 mmol/L; diabetes mellitus complicated by nephropathy for more than 4 years, in July 2008 due to renal failure began peritoneal dialysis treatment, 1, 5% peritoneal dialysis fluid 2000ml 1 time / day + 2, 5% peritoneal dialysis fluid 2000ml 3 times / day, ultra-permeable volume of about Diabetes mellitus complicated by hypertension for more than 4 years, oral antihypertensive drug felodipine extended-release tablets 1 tablet Bid + Colodyn 1 tablet Bid, blood pressure control is basically normal; diabetic retinopathy 2 years, right eye blind for 1.5 years, left eye vision is normal. Smoked for 15 years, 1-2 packs/day, quit smoking in March 2011; drank alcohol for 10 years, about 5 taels/day, quit drinking for 15 years. Denied family history of tumor. In March 2011, a chest X-ray revealed a widened mediastinum and an irregular soft tissue mass in the right upper lung hilar (Figure 1), the patient did not have chest tightness, shortness of breath and other uncomfortable symptoms at that time and did not undergo further examination and treatment. In the chest, multiple enlarged lymph nodes were seen in the tracheal cavernous fossa, in front of the bulge and behind the sternum, and a small amount of pleural effusion on the right side (Figure 2). The nature of the proposed mediastinal occupancy was to be investigated, and the patient was referred to our department for further examination and treatment. During the course of the disease, the patient had no chest pain, coughing blood, fever, etc. In the past 1 week, the patient had poor diet and sleep, 24-hour urine volume was less than 100 ml, and stool was basically normal. Physical examination: T:36,2°C, P:108bpm, R:24bpm, BP:148/94mmHg. clear, anemic appearance, blindness in right eye, superficial lymph nodes not enlarged. The jugular vein was filled, the face, neck and right upper extremity were highly puffy, the frontal lines were superficial, and the left upper extremity was slightly puffy. Respiratory sounds were coarse in both lungs, and the heart rate was 108 beats/minute and in rhythm. The rest was not abnormal. Blood tests: WBC 5,0×109/L, RBC 3,0×1012/L, HB 94g/L, PLT 216×109/L; liver function and electrolytes were not abnormal; renal function: urea nitrogen 20,1mmol/L, creatinine 1180 umol/L, uric acid 270umol/L; lung cancer three: CEA 3,75ng/mL, NSE 89,39ng/mL. Abdominal ultrasound: both kidneys were reduced in volume (left kidney size 7,7×4,3cm, right kidney size 7,4×3,3cm), with clear outline, intact peritoneum, clear corticomedullary boundary, and uniform parenchymal echo; peritoneal effusion, but no other abnormalities were observed. Fasting blood glucose: 5, 48 mmol/L; Treatment: After diuretic, hormone, anticoagulation and prophylactic anti-infection treatment for 2 days, no significant improvement in facial and right upper limb swelling was seen. After full communication with the family about the diagnosis and the risks of chemotherapy, the patient was given chemotherapy with CAV (cyclophosphamide 0,8g + pirarubicin 40mg + vincristine 4mg) regimen on June 4. The patient’s facial and right upper extremity swelling and dyspnea symptoms were slightly relieved 2 days after the end of chemotherapy, in order to relieve the patient’s symptoms as soon as possible on June 6, the right hilar mass was treated with 6MV X-ray radiotherapy, to be 4000cGy/20 times. on June 12, the patient’s symptoms and signs of superior vena cava syndrome were basically completely relieved, diuretic, hormone, anticoagulation and other treatments were stopped, and radiotherapy was continued. on June 30 (19 times of radiotherapy) On June 30 (19 times of radiotherapy), the patient’s chest X-ray was repeated: the right middle lobe of the lung was filled with hyperdense shadow, which was significantly smaller compared with the old film (Figure 3). 2. Discussion: Superior vena cava syndrome (SVCS) is a disease with complete or incomplete remission of symptoms and signs due to multiple causes. SVCS is a clinical syndrome in which the superior vena cava and its major branches are completely or incompletely obstructed by multiple causes, and the venous pressure is elevated or accompanied by the formation of collateral circulation, resulting in edema of the head, face, neck, and upper extremities, as well as bruising and varicose veins in the anterior chest wall. Superior vena cava syndrome is usually secondary to tumors or inflammation of the superior mediastinum, and is caused by malignant tumors in 80% of cases, most commonly bronchopulmonary carcinoma (52%-8l%) and lymphoma (2%-20%), as well as breast cancer, germ cell tumors, gastrointestinal tract tumors such as esophageal cancer, and malignant thymoma. Benign diseases such as syphilis, tuberculosis, idiopathic fibrous mediastinitis, thrombophlebitis, congestive heart failure, and aortic arch aneurysms can also cause [1]. The usual medical treatments are diuresis, dehydration, anticoagulation, and high-dose hormones, which may have a palliative effect. During treatment, it should be noted that mannitol mainly acts as a dehydrating and diuretic agent by increasing plasma and renal tubular osmolarity, thus reducing blood volume and relieving the symptoms of superior vena cava syndrome. In renal failure, mannitol accumulates in the body and cannot be excreted. At this time, the application of mannitol not only does not play a therapeutic role but also increases blood volume and aggravates the patient’s symptoms, which should be regarded as a contraindication. Diuretics mainly act on the kidneys to promote water and sodium excretion, thus achieving the purpose of diuresis and swelling, and diuretics in patients with renal failure do not have a “target” and cannot achieve therapeutic effects. Therefore, the patient’s symptoms did not improve significantly during conventional treatment. Glucocorticoids are insulin antagonist hormones that enhance glycogen xenobiogenesis in the liver, promote hepatic glycogenolysis and inhibit glucose uptake and utilization by peripheral tissues, resulting in elevated blood glucose. We continuously monitored blood glucose during the shock treatment with methylprednisolone (80mg/d), and the blood glucose fluctuated around 12mmol/L, which also proved that diabetic patients can be treated with hormone therapy. The common non-surgical treatments for superior vena cava syndrome are mainly chemotherapy and radiotherapy, and there is a consensus on the combined application of both. However, there is no consensus on how to combine them to achieve the best outcome: chemotherapy or radiotherapy first or both, and the treatment plan is usually decided according to the tumor pathology type and individual patient’s condition. The patient had critical symptoms of chest tightness and shortness of breath, and it was difficult to lie down for a long time, so the effect of radiation therapy was relatively slow and the early radiation congestion and edema might aggravate the disease. method. The patient’s outcome proved that we made the right choice. We admitted a patient who had a large amount of ascites and abdominal distension as the main clinical manifestation, and the diagnosis of peri-pancreatic occupancy was still unclear on abdominal CT. The patient had mild renal impairment at the time of admission and developed unexplained renal failure shortly after admission. We considered the possibility of lymphoma in the patient, and in the absence of better treatment, we gave one course of chemotherapy with EP (etoposide 0,1g d1-5 + cisplatin 20mg d1,30mg d3 intraperitoneal chemotherapy) regimen to control the disease experimentally. The patient’s renal function deteriorated rapidly after the end of chemotherapy, and hemodialysis was ineffective and he eventually died. This suggests that chemotherapy is risky in patients undergoing replacement therapy in renal failure, because many antitumor drugs need to be metabolized and cleared by the kidneys, and the metabolism and clearance pattern of chemotherapy drugs in renal failure under replacement therapy is not clear, and the selection of drug dose is even more difficult. However, in this case report, the patient did not show any significant toxic side effects during chemotherapy. We believe that although patients with renal failure undergoing replacement therapy are at higher risk when receiving chemotherapy, they can tolerate chemotherapy as well as patients with normal renal function by choosing appropriate drugs and doses, and can also obtain better efficacy and prolong life. At present, there are few studies in this area [4], and it is worth to explore further in clinical practice.