Renal cell carcinoma with inferior vena cava thrombus extending to the right atrium diagnosed during pregnancy

Abstract

Only one case of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus diagnosed and treated during pregnancy has been reported in the literature. In that report, the tumor thrombus extended to the infrahepatic IVC (level II tumor thrombus). In the present case, a 37-year-old woman with lupus anticoagulant antibodies was diagnosed with RCC and IVC tumor thrombus extending to the right atrium (level IV tumor thrombus) at 24 weeks of pregnancy. The fetus was safely delivered by cesarean section at 30 weeks of gestation. At 4 days later, an open right radical nephrectomy and IVC and right atrial thrombectomy were performed on cardiopulmonary bypass (CPB) once the patient's hemodynamic status had been optimized. Fetal and maternal concerns included the risk of a thromboembolic event (due to increased hypercoagulability from pregnancy, active malignancy, and lupus anticoagulant), intraoperative hemorrhage risk (due to extensive venous collaterals and anticoagulation), and fetal morbidity and mortality (due to fetal lung immaturity). Standardized guidelines for treatment of RCC with or without IVC tumor thrombus during pregnancy are unavailable due to the infrequency of such cases. Treatment decisions are therefore individualized and this case report may inform the management of future patients diagnosed with RCC with level IV tumor thrombus during pregnancy.

Surgical management of angiomyolipoma with vena cava thrombus during pregnancy: a case report

“…These cases are lack of standardized clinical practice guideline for treatment, while our case is intended to give an available treatment choice. There are also cases reporting renal cell carcinoma (RCC) with IVC thrombus during pregnancy (8). It is reported that tumor thrombus of RCC can extend to the right atrium, level IV IVC thrombus according to the Mayo classification.…”

Renal cell carcinoma diagnosed during pregnancy: a case report and literature review

“…However, cases of RCC that resulted in inferior vena cava thrombosis, haemolytic anaemia, and hypercalcemia have also been reported. 5 …”

“…However, cases of RCC that resulted in inferior vena cava thrombosis, haemolytic anaemia, and hypercalcemia have also been reported. 5 Even though treatment for RCC is surgery, it should be individualized and a multidisciplinary approach should be established because it is rare. Surgery for RCC can be safely performed at every trimester for a patient who is diagnosed during the antenatal period.…”

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

“…Among RCC cases with TT, renal vein invasion is most common, occurring in 10-18%, while involvement of the inferior vena cava (IVC) is seen in 4-23% [1,4]. An additional 1% of TT cases may extend into the right atrium [1,[4][5][6][7]. The majority of renal cancers associated with TT are of clear cell type [8].…”