Presentation
Right flank pain and gross hematuria.
Patient Data
A large heterogeneously enhancing mass in the right kidney is accompanied by peri renal fat stranding and multiple dilated collateral vessels. The mass is extended into the right renal vein up. Focal involvement of the inferior vena cava is also suspected.
At least three stones are noted at the right kidney's lower pole.
A few enlarged lymph nodes with a maximum SAD of 12 mm are observed on the right paraaortic regions.
Case Discussion
The patient went on to have a right radical nephrectomy.
Histology
Renal cell carcinoma, clear cell type, nuclear grade three.
Renal vein: involved.
Inferior vena cava (segmental resection): involved.
Renal capsule and perinephric fat: free of tumor.
Pelvicalyceal system: free of tumor.
Ureter: free of tumor.
Discussion
Intraluminal growth of tumor into the venous circulation, particularly the renal vein, occurs in 4-15% of RCC cases 1. The prognosis is significantly worse for those with IVC involvement compared to renal vein involvement alone, making identification on CT important 2.
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