Recurrence of Renal Cell Carcinoma with Extensive Vena Caval Thrombus Three Years after Radical Nephrectomy

Abstract

A 70-year-old man, who had undergone a radical nephrectomy for localized renal cell carcinoma (RCC) three years ago, was recently evaluated for shortness of breath. During his work-up, a transesophageal echocardiogram and magnetic resonance imaging indicated an extensive vena caval thrombus originating from the renal vein stump. Successful vena caval thrombectomy with cardiopulmonary bypass confirmed that the thrombus was comprised of RCC. This is a rare type of RCC recurrence with an unusual timing (3 years after a nephrectomy), alerting the importance of strict follow-up on all patients even after complete surgical excision of all suspected tumors.

Surgical resection of recurrent inferior vena cava tumor following radical nephrectomy for renal cell carcinoma: A case report

“…A review of the literature and the present case indicated ten published cases of RCC recurring in the IVC with no local recurrence or distant metastases, 9 right and 1 left. Therefore, 90% of local recurrences in reported cases were of right RCC (8)(9)(10)(11)(12). In the present case, the tumor recurrence in the IVC was confirmed in the patient following radical nephrectomy for right RCC.…”

“…Although local recurrence following radical nephrectomy is another biological behavior, which may recur at numerous locations and occurs in 2-3% of patients (7), the late local recurrence of an RCC thrombus extending from the IVC is rare; a thorough review of the published English literature revealed <10 cases, including the present study (8)(9)(10)(11)(12). In the present study, a patient with local recurrence of a tumor thrombus extending from the IVC 4 years after a right radical nephrectomy for advanced RCC is reported.…”

“…From the recorded cases, patients with RCC extending into the IVC primarily presented with clinical signs or symptoms of venous obstruction (1), such as dilated superficial abdominal wall veins, caput medusae, pulmonary embolus or proteinuria (8,9). Owing to a slow-growing tumor thrombus and progressive IVC obstruction, up to 40% of patients reported were asymptomatic.…”

“…However, a reasonable explanation for local recurrence in the IVC is unclear. Associated studies have indicated that local recurrence may be associated with the involvement of the IVC wall, tumor seeding (8,9) or skip metastasis, which had occurred prior to radical nephrectomy. Moreover, the right renal vein is shorter than the left side, which may be more convenient for the migration of tumor cells.…”

Solitary floating vena caval thrombus as a late recurrence of renal cell carcinoma

“…A review of the literature showed only three published cases of RCC recurring in the IVC only, with no local recurrence or distant metastases (Table 1). 6–8 …”