P1-6-6 - A Renal Pelvic Urothelial Carcinoma with an Inferior Vena Cava Tumor Thrombus Treated with Gemcitabine Plus Cisplatin

Abstract

Background: The occurrence of a renal pelvic urothelial carcinoma (UC) with an inferior vena cava (IVC) tumor thrombus is very rare. Chemotherapy with gemcitabine plus cisplatin (GC) is globally established as standard treatment for patients with unresectable metastatic UC. Although standard treatment for local advanced renal pelvic UC has not been established, we report a case of renal pelvic UC with IVC tumor thrombus treated with GC.Case: A 74-year-old woman was admitted to our hospital with progressive upper abdominal pain and increasing fever in the preceding week. Computed tomography scan revealed a large right renal tumor with IVC tumor thrombus extending from the hepatic portal region to both sides of the iliac branch. Urine cytology of the right ureter showed UC cells. The patient was eventually diagnosed with advanced renal pelvic UC and IVC tumor thrombus and was treated with GC for 4 cycles. A partial response to chemotherapy was observed; however, we had to cease chemotherapy owing to hematological toxicity. We planned a right nephroureterectomy and thrombectomy that could not be performed because the tumor directly invaded the duodenum and pancreas. Pathological findings of the abnormal nodes showed metastatic UC.Conclusion: A renal pelvic UC with an IVC tumor thrombus presented with a different tumor extension compared to a renal cell carcinoma with an IVC tumor thrombus. Although continual GC may improve the prognosis of a renal pelvic UC with an IVC tumor thrombus, its use should be further investigated in a large number of patients.