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1.  Contralateral ureteral metastasis 4 years after radical nephrectomy 
Introduction
Metastasis of renal cell carcinoma to the contralateral ureter is extremely rare. To date, only 50 cases of metastatic RCC to the ureter have been reported, among whom 6 cases occur at the contralateral site. We herein report a rare case of metastatic RCC in the contralateral ureter 4 years after radical nephrectomy.
Presentation of case
A 74-year-old man presented with gross, painless hematuria for one month. Computed tomography scan confirmed that a 1.5 cm × 0.5 cm tumor occurred in the contralateral distal ureter. A 3.5 cm segment of ureter was resected and a uretero-vesical anastomosis with psoas hitch was accomplished.
Discussion
The reappearance of hematuria after radical nephrectomy is the most common manifestation of the metastasis to the bladder or ureter. The mechanism of metastasis is not clear. In pathology, vimentin and cytokeratins might help to differentiate between metastatic clear cell renal cell carcinoma and clear cell transitional cell carcinoma.
Conclusion
Metastasis of renal cell carcinoma to the contralateral ureter is rare. Early recognition is extremely important in protecting the remaining renal function and prolonging life-expectancy for post-nephrectomy patients. Complete metastectomy suitable anastomosis have been shown to improve survival.
doi:10.1016/j.ijscr.2011.10.012
PMCID: PMC3267242  PMID: 22288039
Renal cell carcinoma; Ureteral metastasis
2.  Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma 
Objectives:
Budd-Chiari syndrome (BCS) is a poorly understood entity in urology. It results from obstruction of the hepatic veins and the subsequent complications. It has been infrequently reported to be secondary to hepatic venous obstruction from invasion by an inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC). We report the largest known series of patients with RCC and BCS.
Patients and Methods:
Ten patients presented to a tertiary hospital with locally advanced RCC with IVC tumor thrombus. All were evaluated and had clinical or radiographic evidence of BCS. All underwent nephrectomy, IVC thrombectomy or ligation, and tumor removal from the hepatic veins. The perioperative and pathological factors were measured. These included estimated blood loss (EBL) and transfusions. Inpatient factors including duration of intubation, length of intensive care unit (ICU) stay, and overall length of stay (LOS) were recorded. The tumor-free status was evaluated.
Results:
The average age was 59 years. No intraoperative deaths occurred. Two intraoperative complications were noted. The mean EBL was 4244 cc; mean surgery length was 8 hours 12 minutes; and the mean ICU stay was nine days. The overall LOS averaged 13.25 days. One patient died postoperatively of sepsis and multisystem organ failure. One patient required reoperation for an abdominal wall hematoma caused by subcutaneous enoxaparin administration. Average follow-up was 28 months. Five patients are alive with no evidence of disease.
Conclusions:
Budd-Chiari syndrome is a rare entity in urology, with a potential for significant morbidity and mortality. Surgical excision of the primary tumor along with thrombectomy results in alleviation of BCS and improvement in the patient.
doi:10.4103/0970-1591.85439
PMCID: PMC3193735  PMID: 22022058
Budd-Chiari syndrome; hepatic vein thrombus; inferior vena cava thrombus; renal cell carcinoma
3.  Renal cell carcinoma with caval thrombus extending to the right atrium in a horseshoe kidney: a unique surgical challenge 
The surgical anatomy of a horseshoe kidney (HK) is unique in many ways, ranging from its anomalous circulation, shared renal parenchyma between the right and left renal moieties, and its anterior renal pelvis, to the fact that it obscures access to the vena cava and aorta. While renal cell carcinomas (RCCs) are known to occur in HKs, the surgical approach to an RCC with tumour thrombus extending to the right atrium has not been reported in the literature. We report an unusual presentation of RCC and the technical aspects of our successful experience with managing RCC of a HK extending to the inferior vena cava and right atrium.
PMCID: PMC2759664  PMID: 19829720
4.  Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center 
BMC Urology  2013;13:47.
Background
Management of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of surgical management in such patients.
Methods
From February 1995 to February 2013, 520 patients were treated for RCC at Hirosaki University Hospital, Hirosaki, Japan. The RCC patients with tumor thrombus extending to the renal vein (n = 42) and IVC (n = 43) were included in this study. The records of these 85 patients were retrospectively reviewed to assess the relevant clinical and pathological variables and survival. Prognostic factors were identified by multivariate analysis. The benefit of surgical management was evaluated using propensity score matching to compare overall survival between patients who received surgical management and those who did not.
Results
RCC was confirmed by pathological examination of surgical or biopsy specimens in 74 of the 85 patients (87%). Sixty-five patients (76%) received surgical management (radical nephrectomy with thrombectomy). Distant metastasis was identified in 45 patients (53%). The proportion of patients with tumor thrombus level 0 (renal vein only), I, II, III, and IV was 49%, 13%, 18%, 14%, and 5%, respectively. The estimated 5-year overall survival rate was 70% in patients with thrombus extending to the renal vein and 23% in patients with thrombus extending to the IVC. Multivariate analysis identified thrombus extending to the IVC, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Carlson comorbidity index as independent prognostic factors. In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.
Conclusions
Surgical management may improve the prognosis of RCC patients with thrombus extending to the renal vein and IVC.
doi:10.1186/1471-2490-13-47
PMCID: PMC3852853  PMID: 24125174
Renal cell carcinoma; Radical nephrectomy with thrombectomy; Tumor thrombus; Prognostic factors
5.  Renal Cell Carcinoma with Intraluminal Spread of the Entire Upper Urinary Tract 
Case Reports in Medicine  2013;2013:371387.
We describe an unusual case of renal cell carcinoma (RCC) involving the entire upper urinary tract. A 51-year-old female was referred to us because of macroscopic hematuria. Computed tomography revealed a renal tumor filling renal pelvis and ureter, which turned to be a clear cell RCC after nephroureterectomy.
doi:10.1155/2013/371387
PMCID: PMC3664473  PMID: 23737798
6.  Tumor thrombus of inferior vena cava in patients with renal cell carcinoma – clinical and oncological outcome of 50 patients after surgery 
BMC Research Notes  2012;5:264.
Background
To evaluate oncological and clinical outcome in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC) treated with nephrectomy and thrombectomy.
Methods
We identified 50 patients with a median age of 65 years, who underwent radical surgical treatment for RCC and tumor thrombus of the IVC between 1997 and 2010. The charts were reviewed for pathological and surgical parameters, as well as complications and oncological outcome.
Results
The median follow-up was 26 months. In 21 patients (42%) distant metastases were already present at the time of surgery. All patients underwent radical nephrectomy, thrombectomy and lymph node dissection through a flank (15 patients/30%), thoracoabdominal (14 patients/28%) or midline abdominal approach (21 patients/42%), depending upon surgeon preference and upon the characteristics of tumor and associated thrombus. Extracorporal circulation with cardiopulmonary bypass (CPB) was performed in 10 patients (20%) with supradiaphragmal thrombus of IVC. Cancer-specific survival for the whole cohort at 5 years was 33.1%. Survival for the patients without distant metastasis at 5 years was 50.7%, whereas survival rate in the metastatic group at 5 years was 7.4%. Median survival of patients with metastatic disease was 16.4 months.
On multivariate analysis lymph node invasion, distant metastasis and grading were independent prognostic factors. There was no statistically significant influence of level of the tumor thrombus on survival rate. Indeed, patients with supradiaphragmal tumor thrombus (n = 10) even had a better outcome (overall survival at 5 years of 58.33%) than the entire cohort.
Conclusions
An aggressive surgical approach is the most effective therapeutic option in patients with RCC and any level of tumor thrombus and offers a reasonable longterm survival. Due to good clinical and oncological outcome we prefer the use of CPB with extracorporal circulation in patients with supradiaphragmal tumor thrombus. Cytoreductive surgery appears to be beneficial for patients with metastatic disease, especially when consecutive therapy is performed. Although sample size of our study cohort is limited consistent with some other studies lymph node invasion, distant metastasis and grading seem to have prognostic value.
doi:10.1186/1756-0500-5-264
PMCID: PMC3427529  PMID: 22658129
Renal cell carcinoma; Inferior vena cava; Thrombectomy; Tumor thrombus
7.  Antegrade balloon occlusion of inferior vena cava during thrombectomy for renal cell carcinoma 
Nephrectomy with inferior vena cava (IVC) thrombectomy for advanced renal cell carcinoma (RCC) is a challenging and morbid surgical case. We describe the use of a simple endoluminal technique to occlude the suprahepatic IVC during thrombectomy. A 60-year-old male presented with a large right-sided RCC and IVC tumour thrombus. The tip of the thrombus, which was non-adherent to the caval wall, extended to the level of the hepatic veins. After complete dissection of the kidney, we obtained suprahepatic control of the IVC by a large compliant balloon, introduced through the right internal jugular vein and inflated just below the level of the diaphragm. The IVC thrombectomy was performed in a bloodless field. Mean blood pressure remained stable during IVC balloon inflation with a total occlusion time of 10 minutes. Intraprocedural completion cavogram and postoperative Doppler ultrasonography showed no residual IVC clot. Blood loss during the thrombectomy portion of the case was scant. The patient’s postoperative course was uncomplicated and, at the last follow-up, he had stable metastatic disease on sunitinib therapy. For the surgical treatment of RCC with retrohepatic IVC tumour extension, transjugular balloon occlusion of the suprahepatic IVC offers an alternative to extensive hepatic mobilization to obtain suprahepatic thrombus control. Advantages over traditional surgical methods may include decreased surgical time, lower risk of liver injury and tumour embolism. We suggest this method for further evaluation.
PMCID: PMC2911982  PMID: 20694087
8.  Combined resection of a tumor and the inferior vena cava: report of two cases 
Surgery Today  2012;44:166-170.
Tumor resection and caval tumor thrombectomy, with or without cavotomy and inferior vena cava (IVC) replacement are sometimes performed in patients with renal cell carcinoma (RCC) extending into the IVC or liver tumors invading the IVC. Two such cases were treated. Case 1: a 68-year-old female was transferred with a diagnosis of right RCC with tumor thrombus extending into the IVC. A plication was performed to prevent extension into the right atrium before the nephrectomy and cavotomy with removal of the tumor thrombus was accomplished, because the IVC was almost completely obstructed and the hemodynamics were stable during cross-clamping of the IVC. Case 2: a 37-year-old female was transferred with a diagnosis of a giant metastatic liver tumor. A trisegmentectomy with resection of the invaded IVC and IVC replacement was performed while the abdominal aorta was cross-clamped to maintain the hemodynamics. Therefore, abdominal aortic cross-clamping was convenient to maintain the hemodynamics when the IVC replacement was performed during IVC cross-clamping.
doi:10.1007/s00595-012-0337-z
PMCID: PMC3898128  PMID: 23001534
Inferior vena cava tumor thrombus; Inferior vena cava invasion; Renal cell carcinoma
9.  Osteoclast-Like Giant Cell Carcinoma of the Distal Ureter 
Korean Journal of Urology  2011;52(1):68-70.
Extraskeletal osteoclast-like giant cell (OGC) tumors are uncommon and have mainly been found in the breast and pancreas. OGC neoplasms of the urinary tract are extremely rare. Most cases found in the renal pelvis and bladder are associated with either an in situ urothelial malignancy or a conventional high-grade urothelial carcinoma. These malignancies tend to be associated with a poor prognosis and disease course. To our knowledge, no cases of OGC tumors of the distal ureter only have been published. Here, we present the case of a 76-year-old man who underwent hand-assisted laparoscopic nephroureterectomy because of painless gross hematuria with right flank pain. Pathologic examination showed OGC carcinoma of the right distal ureter. No local tumor recurrence or distant metastasis was found at the 5-month follow-up.
doi:10.4111/kju.2011.52.1.68
PMCID: PMC3037510  PMID: 21344034
Giant cell carcinoma; Osteoclasts; Ureter
10.  Successful interdisciplinary treatment of renal cell carcinoma with tumour thrombus into inferior vena cava using multimodal protocol and organ-extending R0 resection in rare horseshoe kidney and doubled right organ 
BMJ Case Reports  2010;2010:bcr04.2009.1802.
This is the first case ever reported showing a combination of renal cell carcinoma (RCC) with tumour thrombus into inferior vena cava (IVC), horseshoe kidney and doubled right kidney that was successfully treated. Even in advanced tumour lesions of the kidney, curative treatment is a feasible and safe option by using interdisciplinary cooperation and expertise. However, this requires an adequate diagnostic work-up to clarify resectability and optimal perioperative and postoperative care, and also advanced surgical skills exhausting all potential options for complete tumour resection in a centre of excellence. Achieving R0 resection with a reasonable risk-benefit ratio for the patient, which should be the primary aim, can distinctly improve survival chances as published cases in literature have indicated. RCC-derived IVC tumour thrombus as an extra-renal tumour manifestation by continuous intravascular tumour growth (also classified as secondary IVC tumour lesion) can be considered no serious contraindication to aim for curative surgery.
doi:10.1136/bcr.04.2009.1802
PMCID: PMC3047170  PMID: 22751093
11.  Renal angiomyolipoma with inferior vena caval thrombus in a 32-year-old male 
Renal angiomyolipoma (AML) rarely presents with evidence of extension into the renal vein, inferior vena cava (IVC) or atrium. We report a case of a renal AML with a tumor thrombus to the IVC in a 32-year-old male. The patient subsequently underwent a right radical nephrectomy with IVC tumor thrombectomy. To our knowledge, there are four published cases of renal AML presenting with tumor thrombus in males. This case report describes the management of the youngest male ever to develop a renal AML with IVC tumor thrombus.
doi:10.4103/0970-1591.57927
PMCID: PMC2808660  PMID: 19955681
Angiomyolipoma; caval thrombus; kidney
12.  A case of renal angiomyolipoma with intracardiac extension and asymptomatic pulmonary embolism 
Angiomyolipoma (AML) is the most common benign tumor of the kidney, which is composed of a mixture of three tissue components: blood vessels, smooth muscle and adipose cells. Occasionally, AML may extend into the renal vein or the vena cava, but so far at least, intracardiac extension was rarely reported. We herein present one case of renal AML with intracardiac extension and pulmonary embolism simultaneously in a 52-year-old Chinese female patient. Contrast-enhanced computed tomography revealed a well-demarcated heterogeneous mass in the right kidney which extended into the right atrium through the right renal vein and inferior vena cava and resulted in embolization in the right pulmonary artery. The renal mass together with the thrombus was resected. The renal mass and thrombus in vena cava and right atrium shared the similar histological features: mature adipose tissue, smooth muscle and thick-walled vessels. The thrombus in the right pulmonary artery was mainly composed of mature adipose tissue. These histological features and the result of positive immunostaining for HMB-45, Melan-A, and smooth muscle actin supported the diagnosis of AML. The component of epithelioid cells was less than 5% and mitosis was rarely seen. Intracardiac extension is often observed in the malignant tumor and only seldom seen in benign tumors. Our case reminds the rare possibility of intracardiac extension in renal AML, which may potentially result in fatal complications if not appropriately managed.
PMCID: PMC3657375  PMID: 23696940
Angiomyolipoma; perivascular epithelioid cell; intracardiac extension; pulmonary embolism; kidney
13.  Management of Locally Advanced Renal Cell Carcinoma with Invasion of the Duodenum 
Case Reports in Surgery  2013;2013:596362.
Renal cell carcinoma (RCC) is rare but aggressive, with greater than 20% of patients presenting with stage III or IV, disease. Surgical resection of the primary tumor regardless of stage is the treatment of choice, and en bloc resection of involved organs provides the only potential chance for cure. This case report describes a patient with metastatic right-sided RCC with invasion of the inferior vena cava and duodenum managed by en block resection and pancreaticoduodenectomy. This report will review the workup and treatment of locally advanced RCC, as well as the role of cytoreductive nephrectomy in the setting of metastatic disease.
doi:10.1155/2013/596362
PMCID: PMC3638526  PMID: 23691422
14.  Pelvic Nephroureterectomy for Renal Cell Carcinoma in an Ectopic Kidney 
We present a case of an ectopic renal tumor in a 61-year-old morbidly obese man with a pelvic kidney found after presenting with hematuria and irritative voiding symptoms. The mass, along with the ectopic kidney and ureter, was radically resected through an open operation that involved removing both them and the renal vessels from the underlying iliac vessels. Pathological analysis demonstrated an 8.3 cm papillary renal cell carcinoma (RCC) with oncocytic features, Fuhrman nuclear grade 3, with angiolymphatic invasion and negative margins. The patient has been recurrence-free for over four years since tumor resection.
doi:10.1155/2012/350916
PMCID: PMC3485500  PMID: 23150838
15.  Renal Cell Carcinoma Associated with Xp11.2 Translocation/TFE3 Gene Fusion: A Rare Case Report with Review of the Literature 
Case Reports in Urology  2013;2013:810590.
Introduction. The recently recognized renal cell carcinomas associated with Xp11.2 translocations are rare tumors predominantly reported in children. Chromosome Xp11.2 translocation results in gene fusion related to transcription factor E3 (TFE3) that plays an important role in proliferation and survival. Case Report. Herein, we present two cases of a TFE3 translocation-associated RCC in young female adults, one detected incidentally and the other one presenting with gross hematuria. Tumor is characterized by immunohistochemistry and a literature review with optimal treatment regimen is presented. Discussion. Xp11.2 translocation RCCs in adult patients are associated with advanced stages, large tumors, and extracapsular disease and usually have an aggressive clinical course. Conclusion. In TFE3 RCC, the genetic background may not only contribute to tumorigenesis, but also determine the response to chemotherapy and targeted therapy. Therefore it is necessary to diagnose this tumor entity accurately. Because of the small number of TFE3 gene fusion-related renal tumors described in the literature, the exact biologic behavior and impact of current treatment modalities remain to be uncertain.
doi:10.1155/2013/810590
PMCID: PMC3881383  PMID: 24455396
16.  Intramedullary Spinal Cord Metastasis in Renal Cell Carcinoma: A Case Report of the Surgical Experience 
Journal of Korean Medical Science  2013;28(8):1253-1256.
Intramedullary spinal cord metastasis (ISCM) from renal cell carcinoma (RCC) is rare manifestation and most of them are treated by adjuvant treatment modalities like radiotherapy. Despite the radio-resistance of RCC itself, focal radiotherapy has been preferred as the first-line treatment modality of ISCM from RCC and only a few cases underwent surgical treatment. We describe a case of ISCM from RCC, which underwent surgical excision and pathologically confirmed. A 44-yr-old man was presented with rapid deterioration of motor weakness during focal radiotherapy for ISCM from RCC. After the surgery for removal of the tumor mass and spinal cord decompression, his motor power was dramatically improved to ambulate by himself. We report the first published Korean case of ISCM from RCC confirmed pathologically and describe our surgical experience and his clinical characteristics.
doi:10.3346/jkms.2013.28.8.1253
PMCID: PMC3744718  PMID: 23960457
Intramedullary Spinal Cord Neoplasm; Metastasis; Renal Cell Carcinoma
17.  Botryoid Wilms’ tumor: a case report and review of the literature 
Here, we report a new case of botryoid Wilms’ tumor, a 4-year-old boy, who was referred to us with a chief complaint of dysuria and gross hematuria. The computed tomography and radical nephroureterectomy showed that a botryoid sarcoma-like appearance occupied the right renal pelvis and extended into the bladder. Histologic examination further confirmed this case was a mixed type of Wilms’ tumor. In a word, we demonstrated a rare case of botryoid Wilms’ tumor, which extended from the renal pelvis into the ureter and bladder, then some degenerative and necrotic tissue with calcification discharged from urethra. Postoperative adjuvant chemotherapy was executed. At 24-month follow-up, there was no evidence of recurrence.
doi:10.1186/1477-7819-11-102
PMCID: PMC3661349  PMID: 23687909
Wilms’ tumor; Botyroid Wilms’ tumor; Renal; Computed tomography; Diagnosis
18.  Concurrent primary carcinoid tumor arising within mature teratoma and clear cell renal cell carcinoma in the horseshoe kidney: report of a rare case and review of the literature 
Primary carcinoid tumor arising in a mature teratoma of the horseshoe kidney is exceptionally rare and only 4 such cases have been reported in the world literature to date. The simultaneous occurrence of different subtypes of renal cell carcinoma (RCC) or RCC coexistence with non-RCC neoplasms from the same kidney is unusual and infrequently reported. Herein we report a case of primary carcinoid tumor arising within mature teratoma, concurrent with a clear cell RCC in the horseshoe kidney of a 37-year-old man. Histologically, both the carcinoid tumor and clear cell RCC demonstrated the characteristic morphology in their classic forms. In addition to the carcinoid tumor, the mature teratoma consisted of variably sized, large cystic spaces lined by cytologically bland mucinous columnar epithelium, pseudostratified columnar epithelium, ciliated epithelium and mature smooth muscle fibers were also identified within the cystic wall. Furthermore, foci of round, small nodules composed of mature prostatic acinus were noted in the teratoma which was confirmed by exhibiting strong immunoreactivity for prostate specific antigen. The present case serves to expand the histologic component that may be encountered in the mature terotoma of the kidney and further broadens the spectrum of primary tumors occurring in the horseshoe kidney.
PMCID: PMC3816830  PMID: 24228123
Kidney; carcinoid tumor; mature teratoma; horseshoe kidney; prostate tissue
19.  Adrenocortical carcinoma extending into the inferior vena cava in a patient with right kidney agenesis: Surgical approach and review of literature 
INTRODUCTION
Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis and the association with tumor thrombus into the inferior vena cava (IVC) is not common. The best treatment is represented by radical surgery.
PRESENTATION OF CASE
We describe a case of a large ACC of the left adrenal gland extending into the IVC through the left renal vein in a young patient with agenesis of the right kidney and signs of acute renal failure. A midline laparotomy was performed, subsequently extended by a left thoracophrenotomy through the 7th intercostal space in order to control the proximal surface of the mass and the thoracic aorta. The tumor was completely excised preserving the kidney, and thrombectomy was performed by a cavotomy with a temporary caval clamping, without cardiopulmonary by-pass (CPB).
DISCUSSION
We discuss surgical approaches reported in literature in case of ACC with intracaval extension. The tumor must be completely resected and the thrombectomy can be performed by different approaches: cavotomy with direct suture, partial resection of caval wall without reconstruction, resection of vena cava with graft reconstruction. These procedures could require a CPB, with an increased mortality. In our case we preserved the kidney and a thrombectomy without CPB was performed.
CONCLUSION
Intracaval extension of ACC does not represent a contraindication to surgery. The best treatment of intracaval thrombus should be the cavotomy with direct suture. The CPB is not always required. In presence of renal agenesis, the preservation of the kidney is mandatory.
doi:10.1016/j.ijscr.2012.03.026
PMCID: PMC3356558  PMID: 22543230
Adrenocortical carcinoma; Inferior vena cava; Thrombectomy
20.  Long-term survival after chemoembolization of metastatic right atrial tumor thrombus as a presenting feature of hepatocellular carcinoma: A case study 
Oncology Letters  2012;3(5):975-977.
Advanced hepatocellular carcinoma (HCC) with invasion into the heart through the hepatic vein is a recognized rare occurrence with an extremely poor prognosis. Patients who present with right heart tumor thrombus have generally been considered inoperable. Although aggressive resection and liver transplantation treatment have previously been performed, the results remain unsatisfactory. However, HCC with extension into the heart usually indicates a contraindication for transcatheter arterial chemoembolization (TACE). In this study, a rare case of HCC with metastatic inferior vena cava (IVC) and right atrial (RA) tumor thrombus was reported. The young patient was admitted to our department due to Budd-Chiari syndrome. Following diagnosis according to CT image findings and laboratory data, the patient underwent TACE therapy. This treatment resulted in a marked reduction in the liver tumor and the right atrial tumor thrombus. Following TACE therapy, the patient survived for 3 years and 10 months and remains alive without any signs of recurrence. This case indicates that TACE therapy can be used successfully for the treatment of advanced HCC with heart tumor thrombus and may result in long-term survival.
doi:10.3892/ol.2012.618
PMCID: PMC3389639  PMID: 22783375
chemoembolization; hepatocellular carcinoma; metastasis; tumor thrombus
21.  A 22-Year-Old Female with Invasive Epithelioid Angiomyolipoma and Tumor Thrombus into the Inferior Vena Cava: Case Report and Literature Review 
Case Reports in Urology  2013;2013:730369.
A 22-year-old female presented with back pain and was discovered to have a right-sided abdominal mass. Computed tomography (CT) scan revealed a 9 cm enhancing right upper pole renal mass with suspicion for tumor thrombus into the right renal vein and possibly the inferior vena cava (IVC). Magnetic resonance imaging (MRI) confirmed tumor thrombus into the inferior vena cava approximately 3 cm below the hepatic venous confluence. Open right radical nephrectomy with inferior vena cava thrombectomy was performed with removal of right kidney and tumor thrombus en bloc. Pathology revealed malignant epithelioid angiomyolipoma (EAML or PEComa). Epithelioid angiomyolipoma is a rare tumor of mesenchymal tissue that has the potential for local invasion and disease progression. Diagnosis of EAML was confirmed by pathology and immunohistochemistry. She was referred to medical oncology for discussion of surveillance versus potential adjuvant therapy and ultimately opted for close surveillance.
doi:10.1155/2013/730369
PMCID: PMC3745915  PMID: 23984176
22.  Xp11.2 translocation renal cell carcinoma occurring during pregnancy with a novel translocation involving chromosome 19: a case report with review of the literature 
Diagnostic Pathology  2009;4:15.
The recently recognized renal cell carcinomas (RCCs) associated with Xp11.2 translocations (TFE3 transcription factor gene fusions) are rare tumors predominantly reported in children. They comprise at least one-third of pediatric RCCs and only few adult cases have been reported. Here, we present a case of Xp11.2 translocation RCC in 26-year-old pregnant female. Her routine antenatal ultrasonography accidentally found a complex cystic right renal mass. Further radiologic studies revealed unilocular cyst with multiple mural nodules at inferior pole of right kidney, which was suspicious for RCC. She underwent right radical nephrectomy at 15 weeks gestation. Macroscopically, the cystic tumor was well encapsulated with multiple friable mural nodules on its inner surface. Microscopically, the tumor consisted of clear and eosinophilic/oncocytic voluminous cells arranged in papillary, trabecular, and nested/alveolar patterns. Occasional hyaline nodules and numerous psammoma bodies were present.
Immunohistochemically, the tumor showed strong nuclear positivity for TFE3. Epithelial membrane antigen, CD10, and E-cadherin were strongly positive. Cytokeratin AE1/AE3, cytokeratin CAM-5.2, calveolin, and parvalbumin were moderately positive. Cytokeratin 7, renal cell carcinoma antigen, and colloidal iron were focally weakly positive. BerEP4 and carbonic anhydrase IX were negative. Cytogenetically, the tumor harbored a novel variant translocation involving chromosomes X and 19, t(X;19)(p11.2;q13.1). Interphase FISH analysis performed on cultured and uncultured tumor cells using a dual-color break-apart DNA probe within the BCL3 gene on 19q13.3 was negative for the BCL3 gene rearrangement. She received no adjuvant therapy, delivered a normal term baby five months later, and is alive without evidence of disease 27 months after diagnosis and surgery. Unlike most recently reported Xp11.2 translocation RCCs in adult patients with aggressive clinical course, this adult case occurring during pregnancy with a novel translocation involving chromosome 19 followed an indolent clinical course.
doi:10.1186/1746-1596-4-15
PMCID: PMC2690580  PMID: 19450277
23.  Cardiovascular Surgery in the Management of Malignant Renal Neoplasms: Survey of 187 Cases in the Literature 
Texas Heart Institute Journal  1983;10(2):163-175.
Transmural or endovascular invasion of regional veins is often a characteristic of malignant renal neoplasms. Tumor thrombus that ascends in the inferior vena cava and sometimes invades the heart seldom adheres to intima. Radical surgical management of malignant renal neoplasms necessitates concomitant extraction of tumor thrombus. This may be achieved by cavotomy alone, but often resection of portions of the suprarenal inferior vena cava (either partial mural cavectomy, or circumferential cavectomy) is also required. Atriotomy is mandatory whenever intracardiac tumor thrombus exists.
Most of the 187 reported operations for venous extension related to malignant renal neoplasms were done in the past decade. Technical problems have included embolism, hemorrhage, and incomplete removal. Because the left kidney is endowed with vast collateral venous channels, right nephrectomy and suprarenal caval interruption are usually well tolerated. Conversely, since the right kidney lacks venous collaterals, survival after left nephrectomy and suprarenal cavectomy hinges on creation of a shunt to divert venous outflow from the remaining kidney.
PMCID: PMC341632  PMID: 15227133
24.  Lymphoepithelioma-Like Carcinoma of the Bladder: A Case Report and Review of the Literature 
Case Reports in Urology  2013;2013:356576.
Lymphoepithelioma-like carcinoma (LELC) in the bladder is uncommon with a reported incidence of 0.4%–1.3% of all bladder carcinomas. In Japan, some occurrences of LELC have been reported in the renal pelvis and ureter but only two in the bladder. A bladder tumor was identified in a 70-year-old man suffering from macroscopic hematuria for 2 months. Sections of the transurethral tumor resection showed invasive high-grade urothelial carcinoma. The patient was diagnosed with local invasive bladder tumor, and cystectomy with ileal conduit formation was performed. The final pathological evaluation was predominant LELC with urothelial carcinoma. We present a new case of LELC in the bladder and performed a review of all published cases of LELC in the urinary tract to obtain its characteristics and prognostic guide.
doi:10.1155/2013/356576
PMCID: PMC3655506  PMID: 23710410
25.  Extensive tumor thrombus in a case of carcinoma lung detected by F18-FDG-PET/CT 
Tumor thrombus is a rare complication of solid cancers, mainly seen in cases of renal cell carcinoma, wilm's tumor, testicular carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma.[1] Tumor thrombus in inferior vena cava is a rare complication of primary carcinoma lung. It should be identified so as to rule out venous thromboembolism and avoiding unnecessary anticoagulant therapy. We describe a case where F18-Fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET/CT) helped to identify extensive tumor thrombus.
doi:10.4103/0972-3919.90269
PMCID: PMC3237216  PMID: 22174524
Carcinoma lung; FDG (Fluorodeoxyglucose) PET/CT; inferior vena cava; tumor thrombus

Results 1-25 (701934)