Massive renal cell carcinoma with tumor thrombus

Case contributed by Dr Michael P Hartung


Abdominal pain.

Patient Data

Gender: Male

Large left renal mass which essential replaces the entire parenchyma, with a bulky exophytic posterior component. Tumor thrombus renal vein to about 1 cm before the IVC resulting in perihilar and pelvic varices (presumed draining in to the internal iliac veins). Borderline lymph nodes adjacent to the hilum. No solid organ metastases. 

MRI manifestations of the same findings described in the CT report. 

Case Discussion

Very large renal cell carcinoma with tumor thrombus in the renal vein. Despite the fact that you might consider an infiltrative urothelial tumor as it appears to overall keep its "reniform shape" especially when reviewing the coronal images, there are two reasons why you can be confident this is RCC:

1. The bulky posterior exophytic component indicates the location of where the mass likely began and over time infiltrated the rest of the kidney (see axial or sagittal images)

2. Tumor thrombus of the renal vein due to urothelial carcinoma is very rare. 

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