Inferior vena cava tumor thrombus after partial nephrectomy for renal cell carcinoma

BMC Research Notes

Yukihiro Kondo²  Yoichiro Yamamoto¹  Go Kimura²  Masato Yanagi²  Takao Shindo²  Tsutomu Hamasaki²  Yasutomo Suzuki²  Jun Akatsuka² 

[1]Division of Diagnostic Pathology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

[2]Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

关键词: Tumor thrombus;    Local recurrence;    Renal cell carcinoma;    Partial nephrectomy;   

Others  :  1134077
DOI  :  10.1186/1756-0500-7-198

 received in 2013-08-06, accepted in 2014-03-27,  发布年份 2014

【 摘 要 】

Background

Partial nephrectomy is now the gold standard treatment for small renal tumors. Local recurrence is a major problem after partial nephrectomy, and local recurrence in the remnant kidney after partial nephrectomy is common.

Case presentation

A 77-year-old man underwent right partial nephrectomy for a T1 right renal cell carcinoma. Microscopic examination revealed a clear cell renal carcinoma, grade 2, stage pT3a. Although the surgical margin was negative, the carcinoma invaded the perirenal fat, and vascular involvement was strongly positive. Thirty months after partial nephrectomy, an enhanced computed tomographic scan showed local recurrence of the renal cell carcinoma extending into the inferior vena cava without renal mass. Hence, we performed right radical nephrectomy and intracaval thrombectomy. Microscopic examination revealed a clear cell carcinoma grade 2, stage pT3a + b. The patient is still alive with no evidence of recurrence 10 months post-procedure.

Conclusion

To our knowledge, local recurrence of renal cell carcinoma extending into the inferior vena cava after partial nephrectomy has not been reported in the literature. Our case report emphasizes the importance of strict surveillance of patients after partial nephrectomy, especially for those with renal cell carcinoma positive for microvessel involvement.

【 授权许可】

   
2014 Akatsuka et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Skinner DG, Pritchett TR, Lieskovsky G, Boyd SD, Stiles QR: Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg 1989, 210:387-394.
• [2]Hatcher PA, Anderson EE, Paulson DF, Carson CC, Robertson JE: Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol 1991, 145:20-24.
• [3]Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H: Matched comparison of radical nephrectomy vs. nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000, 75:1236-1242.
• [4]Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R: A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011, 59:543-552.
• [5]Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Paul R, Uzzo RG: Guideline for management of the clinical Tl renal mass. J Urol 2009, 182:1271-1279.
• [6]Yossepowitch O, Thompson RH, Leibovich BC, Eggener SE, Pettus JA, Kwon ED, Herr HW, Blute ML, Russo P: Positive Surgical Margins at Partial Nephrectomy: Predictors and Oncological Outcomes. J Urol 2008, 179:2158-2163.
• [7]Bernhard JC, Pantuck AJ, Wallerand H, Crepel M, Ferrie’re JM, Bellec L, Maurice-Tison S, Robert G, Albouy B, Pasticier G, Soulie M, Lopes D, Lacroix B, Bensalah K, Pfister C, Thuret R, Tostain J, De La Taille A, Salomon L, Abbou C, Colombel M, Belldegrun AS, Patard JJ: Predictive factors for ipsilateral recurrence after nephronsparing surgery in renal cell carcinoma. Eur Urol 2010, 57:1080-1086.
• [8]Van Poppel H, Vandendriessche H, Boel K, Mertens V, Goethuys H, Haustermans K, Van Damme B, Baert L: Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma. J Urol 1997, 158:45-49.
• [9]Tsui KH, Shvarts O, Smith RB, Figlin RA, deKernion JB, Belldegrun A: Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol 1997, 2000(163):1090-1095.
• [10]Yoshino S, Kato M, Okada K: Prognostic significance of microvessel count in low stage renal cell carcinoma. Int J Urol 1995, 2:156-160.
• [11]Dall’Oglio MF, Ribeiro-Filho LA, Antunes AA, Crippa A, Nesrallah L, Gonçalves PD, Leite KR, Srougi M: Microvascular tumor invasion, tumor size and Fuhrman grade: a pathological triad for prognostic evaluation of renal cell carcinoma. J Urol 2007, 178:425-428.
• [12]NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Kidney Cancer Version 2.2012, 02/16/12 © National Comprehensive Cancer Network, Inc. 2012. http://www.tri-kobe.org/nccn/guideline/urological/english/kidney.pdf#search=’NCCN webcite+clinical+practice+guideline+kidney+cancer’