Angiomyolipoma with vena caval extension

Abstract

69-year-old woman of the Jehovah’s Witness faith was found to have a mass on a computed tomography bone density scan done for osteoporosis. Computed tomography demonstrated a 10-cm right renal mass with a tumor thrombus extending to the level of the hepatic veins (Fig. 1). Both the computed tomography and magnetic resonance imaging scans demonstrated fat within the tumor, consistent with an angiomyolipoma or a liposarcoma (Fig. 2). No metastatic disease was evident. A right radical nephrectomy was performed with a retroperitoneal lymphadenectomy and level II thrombectomy using a thoracoabdominal approach 1 (Fig. 3). Erythropoietin was given preoperatively, and her starting hematocrit was 50%. Vascular control was obtained intraoperatively by mobilizing the liver off the inferior vena