scholarly journals Metastatic Renal Cell Carcinoma with Level IV Thrombus: Contemporary Management with Complete Response to Neoadjuvant Targeted Therapy

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Abhishek Bhat ◽  
Bruno Nahar ◽  
Vivek Venkatramani ◽  
Indraneel Banerjee ◽  
Oleksandr N. Kryvenko ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Vena Cava ◽  
Significant Risk ◽  
Complete Response ◽  
Evolutionary Stage ◽  
Urological Cancers ◽  
The Right

Renal cell carcinoma, particularly the most common clear cell type, is one of the most aggressive of urological cancers with significant risk of metastatic spread. It also has a propensity for venotropism with a proportion of tumors developing thrombi up to the right atrium. The response with newly adopted targeted therapy has been considered to be in the evolutionary stage with no clear role with respect to debulking or reducing the size of the inferior vena cava (IVC) thrombus. We describe a case of a right-sided metastatic RCC with Level IV thrombus initially managed with Pazopanib followed by Nivolumab and Adalimumab followed by cytoreductive nephrectomy and IVC thrombectomy in the post-targeted therapy setting with complete curative response.

scholarly journals Spermatic Vein Tumor Thrombus In Renal Cell Carcinoma

2004 ◽  
Vol 4 ◽  
pp. 192-194 ◽  
Author(s):  
Nicola J. Mabjeesh ◽  
Yuval Bar-Yosef ◽  
Letizia Schreiber-Bramante ◽  
Issac Kaver ◽  
Haim Matzkin
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
English Literature ◽  
Vena Cava ◽  
Spermatic Vein ◽  
Renal Veins ◽  
The Right

Renal cell carcinoma has the tendency to form venous thrombi. This may involve the renal veins or the inferior vena cava and may extend cephalad/antegrade into the right atrium. We report a patient with renal cell carcinoma who had an intracaval tumor thrombus that had extended into the right spermatic vein. We believe this to be the first description in English literature of a histologically proven renal cell carcinoma thrombus in the spermatic vein.

scholarly journals Complete response of renal cell carcinoma vena cava tumor thrombus to neoadjuvant immunotherapy

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Craig Labbate ◽  
Ken Hatogai ◽  
Ryan Werntz ◽  
Walter M. Stadler ◽  
Gary D. Steinberg ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Vena Cava ◽  
Complete Response ◽  
Neoadjuvant Immunotherapy

Normothermic Cardiopulmonary Bypass with Beating Heart for Management of Renal Cell Carcinoma with Atrial Tumor Thrombus

2013 ◽  
Vol 8 (4) ◽  
pp. 316-319 ◽  
Author(s):  
Domenico Calcaterra ◽  
Thomas E. Collins ◽  
Joseph W. Turek ◽  
Kalpaj R. Parekh ◽  
Mohammad Bashir ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cardiopulmonary Bypass ◽  
Cell Carcinoma ◽  
Right Atrium ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Vena Cava ◽  
Hospital Length Of Stay ◽  
Advanced Tumor Stage ◽  
The Right

Renal cell carcinoma is occasionally complicated by the formation of a neoplastic thrombus invading the inferior vena cava. Rarely, the thrombus extends into the vena cava, reaching the right atrium. In these situations, despite the advanced tumor stage, surgical resection continues to offer the best chance for effective treatment. The operation requires a complex surgical approach with mobilization of the liver and use, in most cases, of extracorporeal circulation, which allows removal of the tumor thrombus from the right atrium. Traditionally, the intervention is performed using deep hypo-thermic circulatory arrest or, less frequently, using moderate hypothermia, aortic cross clamping, and cardioplegic cardiac arrest. These strategies have the downside of causing increased blood loss, coagulopathy, and long operative time and can potentially have a negative impact on survival. We report a different operative approach using normothermic cardiopulmonary bypass, with the expectation of lowering the rate of blood product transfusions, hospital length of stay, and overall incidence of complications.

scholarly journals Axitinib Induced Recurrent Pneumothorax following Near-Complete Response of Renal Cell Carcinoma Lung Metastasis: An Unexpected Complication

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Francisco Socola ◽  
Arturo Loaiza-Bonilla ◽  
Pasquale Benedetto
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Main Pulmonary Artery ◽  
Tension Pneumothorax ◽  
Clinical Trial Data ◽  
Major Complication ◽  
Complete Response ◽  
Before And After

We report a case of a Caucasian male with a history of renal cell carcinoma metastatic (mRCC) to the lungs refractory despite aggressive treatment with several lines of targeted therapy. He was started on axitinib palliative targeted therapy with a good clinical and radiological response; however one month after treatment initiation he presented to the emergency department with severe dyspnea and hypoxemia. Physical exam and chest X-ray revealed left-sided tension pneumothorax which required emergent thoracostomy with subsequent improvement; however it recurred requiring video assisted thoracoscopy. A left-sided 4 × 3 cm cavitated necrotic lesion was found at the level of the main pulmonary artery. Repair with pericardial fat flap was performed. Surgical biopsies from this lesion revealed mRCC with extensive necrosis. Imaging studies before and after axitinib use showed an initial 4 × 3 cm mass seen in the same location of this large cavitated necrotic tumor. Pneumothorax has not been described as a potential major complication from the use of axitinib. Complete or near-complete responses of mRCC to axitinib targeted therapy may lead to this potential life-threatening complication, particularly if the metastatic lesions are located near to pleural structures. We also review pertinent clinical trial data on axitinib.

scholarly journals Selective Upper-Body Perfusion Technique for Removal of Renal Cell Carcinoma Extending into the Inferior Vena Cava and Right Atrium

2017 ◽  
Vol 44 (4) ◽  
pp. 283-286
Author(s):  
Selim Aydin ◽  
Bora Cengiz ◽  
Banu Vural Gokay ◽  
Anar Mammadov ◽  
Remzi Emiroglu ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Inferior Vena Cava ◽  
Cell Carcinoma ◽  
Right Atrium ◽  
Renal Cell ◽  
Inferior Vena ◽  
Vena Cava ◽  
Upper Body ◽  
Surgical Field ◽  
The Right

Invasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava is particularly challenging because the liver covers the surgical field. We report the case of a 61-year-old man who underwent surgery for a renal cell carcinoma of the right kidney that extended into the inferior vena cava and right atrium. During dissection of the liver to expose the inferior vena cava, transesophageal echocardiograms revealed right atrial mass migration into the tricuspid valve. On emergency sternotomy, the tumor embolized into the main pulmonary artery. We used a selective upper-body perfusion technique involving moderately hypothermic cardiopulmonary bypass, cardioplegic arrest, and clamping of the descending aorta, which provided a bloodless surgical field for precise removal of the mass and resulted in minimal blood loss. Our technique might be useful in other patients with tumor thrombus extending into the right atrium because it reduces the need for transfusion and avoids the deleterious effects of deep hypothermic circulatory arrest. Our case also illustrates the importance of continuous transesophageal echocardiographic monitoring to detect thrombus embolization.

scholarly journals Multiple Primary Synchronous Renal Cancer and Thyroid Gland Cancer at Patient with Doubling Inferior Vena Cava and Renal Veins on Both Sides (Clinical Case)

2017 ◽  
pp. 36-43
Author(s):  
Yu. A. Stepanova ◽  
A. A. Teplov ◽  
M. V. Morozova ◽  
A. A. Gritskevich ◽  
S. S. Pyanikin ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Inferior Vena ◽  
Ex Vivo ◽  
Vena Cava ◽  
Cold Ischemia ◽  
Renal Veins ◽  
Multiple Primary ◽  
The Right

Renal cell carcinoma – the third on occurrence frequency tumor of urinogenital system and the most widespread renal tumor which makes about 2–3% of malignancies at adults. Doubling of inferior vena cava (IVC) is anomaly in case of which two inphrarenal segments of IVC are defined. Left IVC after lockin in it the left renal vein crosses an aorta in front, connects to the right renal vein and the right IVC. Combination of renal cell carcinoma and doubling IVC is rather seldom. The presented clinical case of a combination of renal cell carcinoma and doubling of IVC has the feature existence at the patient of metachronous multiple primary neoplasms that does necessary more careful inspection of the patient. Also a doubling of renal veins on both sides and a doubling of the left renal artery have been revealed. Possibilities of presurgical non-invasive diagnostics (ultrasonography and computer tomography) of retroperitoneal space vessels anomaly at the patient with transmural localization of kidney tumor allowing to plan and execute difficult surgery – an ex vivo resection of a left kidney in the conditions of pharmacological cold ischemia was shown. Performance of an ex vivo nephrectomy in the conditions of pharmacological cold ischemia allows to dilate indications to organ-preserving treatment of patients with the localized kidney cancer. However long cold ischemia and the subsequent vascular reconstruction demand dynamic observation over kidney’s functional conditions.

scholarly journals Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

2015 ◽  
Vol 42 (1) ◽  
pp. 66-69 ◽  
Author(s):  
Magdy M. El-Sayed Ahmed ◽  
Raed M. Al-Najjar ◽  
Muhammad Aftab ◽  
James M. Anton ◽  
John S. Colen ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Early Detection ◽  
Cell Carcinoma ◽  
Transesophageal Echocardiography ◽  
Renal Cell ◽  
Inferior Vena ◽  
Vena Cava ◽  
Tumor Embolization ◽  
Pulmonary Tumor ◽  
The Right

Pulmonary tumor embolization from renal cell carcinoma is associated with severe cardiopulmonary morbidity and high perioperative mortality rates. We report the case of a 71-year-old woman who presented with right-sided abdominal pain. Magnetic resonance images revealed a mass originating from the upper pole of the right kidney and extending into the infrahepatic portion of the inferior vena cava. Transesophageal echocardiography was continuously used to monitor the mass during intended radical nephrectomy and tumor resection. When the right kidney was mobilized, intracaval thrombus detached and migrated to the patient's right atrium, causing severe hemodynamic instability. After emergent sternotomy and during the initiation of cardiopulmonary bypass, the mass was no longer echocardiographically detectable in the heart; it was soon removed completely from the left pulmonary artery. The mass was a renal cell carcinoma. We recommend the use of transesophageal echocardiography as an efficient diagnostic tool in the early detection of pulmonary tumor embolization during the resection of renal cell carcinoma that involves the inferior vena cava.

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