Renal cancer with tumor thrombus level iv: case report

Renal cell carcinoma (RCC) can be characterized as a neoplasm prone to extension to the venous system in the form of thrombus tumor, more frequently, when malignant, to the vena cava. The clinic is often nonspecific until the advanced stage of the disease, with a classic triad of flank pain, hematuria, and a palpable abdominal mass appearing in only 6-10% of cases. Non-invasive imaging exams play an increasingly important role. When there is associated tumor thrombus, curative therapy necessarily involves multidisciplinary surgical intervention, consisting in the removal of the kidney and tumor thrombus, and in particular situations cardiac intervention may be associated. In this paper we present the case of a 35-year-old man, oligosymptomatic, who was diagnosed with an incidental mass in the right kidney through urinary tract ultrasound. The diagnostic investigation was complemented with computed tomography and computed phlebography, confirming a solid lesion measuring 73x52x47mm, with invasion of the inferior vena cava and right atrium. The patient underwent right radical nephrectomy with excision of the thrombus from the inferior vena cava to the right atrium under cardiopulmonary bypass with deep hypothermic arrest. Histology revealed clear-type renal cell carcinoma. Surgery and postoperative uneventful. The patient remained in outpatient follow-up, with local recurrence 6 months after surgery. Being referred to clinical oncology and undergoing immunotherapy and chemotherapy, which is followed up.