Giant renal tumor with inferior vena cava thrombus – a case report

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INTRODUCTION: Vascular migration and venous tumor thrombus are infrequent but unique aspects of renal cell carcinoma, and these features have significant therapeutic and prognostic implications. We report a case of renal neoplasm with a vena cava tumor thrombus treated with surgical resection and adjuvant chemotherapy.
CASE REPORT: A 53-year-old, otherwise healthy woman presented to the emergency department due to macroscopic hematuria and abdominal pain. A large abdominal mass was noted. A computed tomography angiography was performed, and a right renal tumor (105x207mm) with level II inferior vena cava tumor thrombus and local adenopathy was noted. After a multidisciplinary discussion, she was proposed for surgical resection. Through a bilateral subcostal incision (Chevron), a standard right radical nephrectomy and perivascular lymph node excision were performed. The IVC was exposed, and a thrombectomy was performed through a longitudinal cavotomy. Pathology revealed clear renal cell carcinoma and lymph node metastasis. The postoperative period was uneventful. However, the patient developed multiple liver and lung metastases at early follow-up and was treated with chemotherapy.
DISCUSSION: Tumor thrombus can extend up to the right atrium and occurs in nearly 10–25% of renal cell carcinoma patients. The natural history of this condition is poor, with a median survival of 5 months and significant survival improvements following radical nephrectomy and IVC tumor thrombus removal are observed, with 40-60% 5-year survival. Surgical treatment should, therefore, be considered in this group of patients. Such operations can be challenging, particularly when thrombus extent is significant, and the combination of efforts between oncologists, urologists, and vascular surgeons can improve patient safety and perioperative outcomes with significant improvements in overall prognosis.