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Tian X, Hong P, Tang S, Liu Z, Yang F, Zhang S, Wang G, He H, Ma L. Urothelial carcinoma of the renal pelvis with renal vein and inferior vena cava tumor thrombus: case series and literature review. Transl Androl Urol 2021; 10:2879-2888. [PMID: 34430390 PMCID: PMC8350241 DOI: 10.21037/tau-21-253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background Urothelial carcinoma (UC) of the renal pelvis with renal vein and inferior vena cava (IVC) tumor thrombus (TT) was extremely rare. We aimed to explore the clinical and pathological characteristics, diagnosis and treatment of renal pelvis UC with renal vein and IVC TT. Methods From March 2016 to January 2019, eight patients of renal pelvis UC with renal vein and IVC TT were diagnosed and underwent operation in our hospital. Clinical features, operative details, pathological outcomes, and prognosis data were reviewed and collected. Results There were five males and three females (52-84 years old). Their main symptoms were flank pain and hematuria. According to the Mayo classification, the TT was 4 level-0 (1 left and 3 right), 2 level-I (right), and 2 level-II (right). Half the patients underwent retroperitoneal laparoscopic radical nephroureterectomy with thrombectomy, and the other underwent open procedures. The mean operative time was 298.9 minutes. Pathological outcomes revealed high-grade UC, with positive lymph nodes in 6 cases. Four patients received adjuvant chemotherapy, one target therapy and one adjuvant chemotherapy combined with immunotherapy after surgery. The mean follow-up time was 11.1 months. Three patients are alive, and two of them developed recurrence and lung metastasis. Conclusions Preoperative differentiation between renal pelvis UC and renal cell carcinoma with venous TT was very important for the management. Radical nephroureterectomy with thrombectomy might be a reasonable method for renal pelvis UC with venous TT. The prognosis of such cases was poor even if adjuvant therapy was scheduled.
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Affiliation(s)
- Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Feilong Yang
- Department of Urology, Peking University Third Hospital, Beijing, China.,Department of Urology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Huiying He
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Li M, Shi A, Kong W, Zhang J, Chen Y, Huang J, Huang Y. Transitional cell carcinoma with extension of the renal vein and IVC tumor thrombus: report of three cases and literature review. World J Surg Oncol 2016; 14:309. [PMID: 28031042 PMCID: PMC5192594 DOI: 10.1186/s12957-016-1041-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background Transitional cell carcinoma (TCC) originating from the renal pelvis with a venous tumor thrombus is a rare entity. However, clinicians should be aware of it because of its high malignancy and poor prognosis. Case presentation Here, we report three cases of pathologically confirmed TCC originating from the renal pelvis with extension into the renal vein or inferior vena cava (IVC). Of these patients, two are males and one is female (58~73 years old). Their main symptom is flank pain; besides, gross hematuria and weight loss is observed in one of the patients. Computed tomography (CT) scan of the first patient revealed multiple space-occupying lesions in the left renal pelvis and left medium and lower ureter with a tumor thrombus in the left renal vein. CT scan of the second patient revealed a right renal mass and extension into the IVC. Abdominal magnetic resonance imaging (MRI) of the third patient showed a soft tissue mass in the region of the left renal sinus, and the signal of the soft tissue was observed in the left renal vein. The preoperative diagnoses of the first and third patient were TCC, while the second patient was renal cell carcinoma (RCC). Two patients with the preoperative diagnosis of TCC underwent laparoscopic radical nephroureterectomy with thrombectomy, and the other patient underwent radical nephrectomy with thrombectomy. The surgeries were successful. Although two of our patients underwent chemotherapy and radiotherapy, they died 2 and 19 months after the surgery, respectively. The other patient refused any adjuvant therapy and died 3 months after the operation. Conclusions Compared to the extension of RCC to the renal vein or IVC, extension of TCC to the renal vein or IVC is rare. TCC with a venous tumor thrombus is often misdiagnosed as RCC. However, a correct preoperative or intraoperative diagnosis is of great importance to decide surgical strategy. Laparoscopic radical nephroureterectomy with thrombectomy may be a safe and feasible operative method in treatment of TCC with a renal vein thrombus. The prognosis of such cases is poor even if chemotherapy and radiotherapy are scheduled.
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Affiliation(s)
- Mingyang Li
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - An Shi
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Wen Kong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jin Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Yonghui Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jiwei Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
| | - Yiran Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
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Pouliot F, Shuch B, LaRochelle JC, Pantuck A, Belldegrun AS. Contemporary Management of Renal Tumors With Venous Tumor Thrombus. J Urol 2010; 184:833-41; quiz 1235. [DOI: 10.1016/j.juro.2010.04.071] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Frédéric Pouliot
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brian Shuch
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey C. LaRochelle
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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4
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Juan YS, Jang MY, Shen JT, Chou YH, Huang CH, Hsieh TJ. Transitional cell carcinoma of the renal pelvis with extension into the inferior vena cava: a report of two cases. Kaohsiung J Med Sci 2003; 19:362-7. [PMID: 12926523 DOI: 10.1016/s1607-551x(09)70439-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Of all primary malignant renal tumors, 10% to 15% originate from the renal pelvis, and 90% to 92% of these tumors are transitional cell carcinomas. Nonetheless, renal pelvis transitional cell carcinoma extending into the inferior vena cava is very rare. We report one confirmed case and one highly suspicious case of renal pelvis transitional cell carcinoma with a tumor thrombus in the inferior vena cava. Both of our patients died within 6 months of initial diagnosis, indicating the poor prognosis and advanced stage of transitional cell carcinoma with an inferior vena cava thrombus. Transitional cell carcinoma should be considered in patients with obstruction of the renal vein and the inferior vena cava.
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Affiliation(s)
- Yung-Shun Juan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
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5
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Miyazato M, Yonou H, Sugaya K, Koyama Y, Hatano T, Ogawa Y. Transitional cell carcinoma of the renal pelvis forming tumor thrombus in the vena cava. Int J Urol 2001; 8:575-7. [PMID: 11737488 DOI: 10.1046/j.1442-2042.2001.00373.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 47-year-old man presented with a left renal incidentaloma without hematuria. The tumor was complicated by inferior vena cava (IVC) thrombus extending from Th11 to L4. A temporary IVC filter was introduced prior to surgery. A midline incision was used to perform a left radical nephrectomy and en bloc lymphadenectomy with excision of the inferior vena cava from above the level of the left renal vein to 2.5 cm above the confluence of the common iliac veins. The pathological diagnosis was invasive transitional cell carcinoma. The tumor thrombus consisted of transitional cell carcinoma that histologically invaded the walls of the IVC. He died of cancer 17 months after the operation for the liver metastases. This is the 18th case report of such a presentation in the literature.
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Affiliation(s)
- M Miyazato
- Department of Urology, University of the Ryukyu, Okinawa, Japan.
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Tajima T, Yoshimitsu K, Honda H, Kuroiwa T, Irie H, Makisumi K, Masuda K, Abe Y, Naitou S. Hypervascular renal transitional cell carcinoma with extension into the renal vein and inferior vena cava. Comput Med Imaging Graph 1997; 21:365-8. [PMID: 9690013 DOI: 10.1016/s0895-6111(97)00034-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A rare case of transitional cell carcinoma (TCC) with extension into the renal vein and inferior vena cava (IVC) is presented. Computed tomography, magnetic resonance imaging, and angiography successfully delineated tumor thrombus in the right renal vein and IVC. TCC should be included in the differential diagnosis of renal tumors that can cause IVC thrombosis.
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Affiliation(s)
- T Tajima
- Department of Radiology, Faculty of Medicine, Kyushu University Hospital, Fukuoka, Japan
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7
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Williams JH, Frazier HA, Gawith KE, Laskin WB, Christenson PJ. Transitional cell carcinoma of the kidney with tumor thrombus into the vena cava. Urology 1996; 48:932-5. [PMID: 8973682 DOI: 10.1016/s0090-4295(96)00312-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Transitional cell carcinoma of the upper urinary tract with inferior vena cava tumor thrombus is an unusual entity. We report the 16th such case and review the previous cases in the world literature. Preoperative diagnosis was correct in only 5 of the cases. This type of condition can be easily presumed to be renal cell carcinoma. Fifteen of the cases were managed with radical nephrectomy; 8 patients were managed with partial or complete resection of the vena cava due to adherence of the tumor thrombus to the vessel wall. Overall outcome was poor, with short postoperative survival. Correct preoperative diagnosis, although difficult, could allow more complete preoperative planning or appropriate nonoperative management.
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Affiliation(s)
- J H Williams
- Department of Urology, National Naval Medical Center, Bethesda, Maryland 20889, USA
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Kibel A, Downs T, Bubley G, DeWolf W. Squamous Cell Carcinoma Of The Renal Pelvis With Inferior Vena Caval Extension. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65611-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A.S. Kibel
- Departments of Surgery (Division of Urology) and Medicine (Division of Medical Oncology), Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
| | - T.M. Downs
- Departments of Surgery (Division of Urology) and Medicine (Division of Medical Oncology), Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
| | - G.J. Bubley
- Departments of Surgery (Division of Urology) and Medicine (Division of Medical Oncology), Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
| | - W.C. DeWolf
- Departments of Surgery (Division of Urology) and Medicine (Division of Medical Oncology), Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
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