Invading of Renal Cell Carcinoma in Inferior Vena Cava and Right Atrium with a Huge Metastatic Thrombus

Abstract

BACKGROUND: Renal cell carcinoma (RCC) with cavoatrial involvement represents a major surgical challenge. Several surgical techniques for the treatment of these tumors have been proposed, but due to a small number of patients and limited follow-up, substantial controversy about the best operative management still exists. CASE REPORT: A 54-year-old woman, with no previous comorbidities, comes to the emergency room with low back pain, weight loss, and edema of the lower legs that computed tomography revealed a massive infiltrative expansive formation in the abdomen that affected practically the entire right kidney, measuring 8.2 cm × 7.6 cm that invaded the collecting system and was in close contact with the right hepatic lobe and the head of the pancreas. During the intervention, infiltration of the renal vein on this side is found, and the inferior vena cava (IVC) that extends in its intrahepatic part, up to the junction of the suprahepatic veins, with almost complete closure of the lumen accompanied by the presence of retroperitoneal lymph nodes, with size up to 10 mm. CONCLUSION: Advanced extension of RCC can occur with no apparent symptoms and be detected incidentally. In rare circumstances, atypical presentation of RCC should be considered in a patient presenting with the right atrial mass detected by echocardiography. RCC with IVC and right atrium extension is a complex surgical challenge, but excellent results can be obtained with proper patient selection, meticulous surgical techniques, and close perioperative patient care.