Abstract
A 67-year-old man consulted our department with gross hematuria. Computed tomography (CT) revealed a huge renal tumor with a paracaval metastatic lymph node (mLN). Right total nephrectomy was planned for the renal tumor diagnosed as renal cell carcinoma preoperatively. Just before the resection of the renal vein and artery, intraoperative ultrasonography revealed an inferior vena caval tumor thrombus (IVCTT) extending from the mLN. Ultrasonography clearly and dynamically demonstrated a rhythmic flapping movement of the IVCTT with blood flow in the inferior vena cava. Following right radical nephrectomy, IVCTT resection with the vessel wall was performed to reduce the risk of pulmonary tumor thrombus. Histopathological diagnosis of the renal tumor was clear cell renal cell carcinoma, and the resected IVCTT was confirmed histopathologically as tumor involvement from the mLN of the renal cell carcinoma. Intraoperative ultrasonography can detect IVCTT extending from the mLN, whereas CT cannot.
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References
Giuliani L, Giberti C, Martorana G, Rovida S. Radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors. J Urol. 1990;143:468–73 (discussion 473-64).
Hoehn W, Hermanek P. Invasion of veins in renal cell carcinoma—frequency, correlation and prognosis. Eur Urol. 1983;9:276–80.
Novick AC, Cosgrove DM. Surgical approach for removal of renal cell carcinoma extending into the vena cava and the right atrium. J Urol. 1980;123:947–50.
Goldfarb DA, Novick AC, Lorig R, et al. Magnetic resonance imaging for assessment of vena caval tumor thrombi: a comparative study with venacavography and computerized tomography scanning. J Urol. 1990;144:1100–3 (discussion 1103-4).
Hallscheidt P, Pomer S, Roeren T, Kauffmann GW, Staehler G. Preoperative staging of renal cell carcinoma with caval thrombus: is staging in MRI justified? Prospective histopathological correlated study. Urologe A. 2000;39:36–40.
Laissy JP, Menegazzo D, Debray MP, et al. Renal carcinoma: diagnosis of venous invasion with Gd-enhanced MR venography. Eur Radiol. 2000;10:1138–43.
Sigman DB, Hasnain JU, Del Pizzo JJ, Sklar GN. Real-time transesophageal echocardiography for intraoperative surveillance of patients with renal cell carcinoma and vena caval extension undergoing radical nephrectomy. J Urol. 1999;161:36–8.
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This case report was approved by the Ethics Committee of Shinshu University School of Medicine (Permission No. 3741-2017).
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Minagawa, T., Fukui, D., Shingu, K. et al. Intraoperative detection of inferior vena caval tumor thrombus extending from metastatic lymph node of renal cell carcinoma using ultrasonography. J Med Ultrasonics 45, 367–370 (2018). https://doi.org/10.1007/s10396-017-0838-x
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DOI: https://doi.org/10.1007/s10396-017-0838-x