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Right renal mass with extension to the renal vein and inferior vena cava.

N. Simforoosh - M. Parvin - F. Tajali - MA. Falah

Case presentation

A 53 year old male was referred to Labbafinejad Medical center with a chief complaint of discoloration of urine. The patient suffered no other symptoms rather than gross hematuria including weight loss, flank pain and lower urinary symptoms. Physical examination revealed no abnormal signs. The patient had no history of smoking and drug or alcohol abuse.

Ultrasound study revealed a heterogeneous cystic mass of 73 mm diameter adjacent to the hilum of right kidney. The laboratory tests before the operation showed that the patient had high serum levels of LDH (517 U/L) and CPK (1180 IU/L). Serum levels of hemoglobin,Calcium and Liver Enzymes were reported as normal.

CT SCAN

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 Computed Tomography with intravenous contrast indicated a large, heterogeneous soft tissue mass in the right kidney with contrast enhancement.   

MRI  

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Magnetic Resonance Imaging showed a vascularized and heterogeneous mass in the right kidney consistent with neoplastic lesion which invaded right renal vein and IVC.

 

Surgical procedure

The patient underwent Radical Nephrectomy of Right kidney using thoracho abdominal incision. While the tumor had adhesions to the soft tissues and liver, Inferior Vena Cava was macroscopically involved.

 

Pathology

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Renal Cell Carcinoma; clear cell type. Nuclear grade: 2/6.  Pathologic stage was pT3a Nx Mx.

 

Edited by: Mohammad Hossein Soltani

(Jun -2011)


Submission: 11/17/2011, Modified: 11/17/2011