Renal Pelvic Cancer with Tumor Thrombus in the Vena Cava Inferior

Abstract

Renal pelvic cancer with a large vein tumor thrombus is very rare. We report a case of transitional cell carcinoma of the right renal pelvis with tumor thrombus in the inferior vena cava. Based on the radiological findings, the patient was diagnosed having renal cell carcinoma with tumor thrombus in the vena cava preoperatively. Radical nephrectomy with thrombectomy was performed. A literature review of 17 reported cases revealed that 13 cases (76.5%) were diagnosed as renal cancer preoperatively. Prognosis of transitional cell carcinoma with vena cava tumor thrombus is relatively poor compared to that of renal cell carcinoma with a large vein tumor thrombus.

Surgical Treatment of Inferior Vena Cava Invasion in Patients with Renal Pelvis Transitional Cell Carcinoma by Use of Human Cadaveric Aorta

“…However, venous infiltration by transitional cell carcinoma of the renal pelvis remains rarely reported [1-3]. Few renal pelvic tumors extend into the IVC, and it is very rare that they invade the wall of the IVC [3]. …”

“…When a patient presents with signs and symptoms such as lower-extremity edema, varicocele, albuminuria, pulmonary embolism, or urographic dysfunction of the involved kidney, tumor extension into the IVC should be suspected before removing the renal tumor [1-5]. Nevertheless, the majority of patients with extension of tumor into the renal vein and IVC are asymptomatic, and the diagnosis is usually made radiologically [1-3,7]. …”

“…Urine cytology and brushings from the involved renal pelvis may aid in correct diagnosis, although a frozen section of the tumor upon removal of the specimen may be necessary to exclude transitional cell carcinoma. Similarly to the case of RCC, aggressive surgical treatment is indicated in all patients with renal tumors associated with IVC invasion, because nephrectomy alone is associated with dismal prognosis [3,4]. However, IVC resection is an uncommon and challenging procedure.…”

“…It accounts for less than 1% of genitourinary neoplasms and 5 to 7% of all urinary tract tumors [1,2]. Extension of transitional cell carcinomas into the vena cava is rarely reported in the literature [3]. Most data available are derived from retrospective studies, and surgery is the mainstay of treatment.…”

“…Most data available are derived from retrospective studies, and surgery is the mainstay of treatment. Aggressive surgery to remove an inferior vena cava (IVC) thrombus is reported to be effective in prolonging survival in patients with renal cell carcinoma (RCC) [3,4]. However, the value of aggressive surgery in the treatment of transitional cell carcinoma of the renal pelvis remains unclear owing to limited evidence and the aggressive course of the condition.…”