Renal Cell Carcinoma with Direct Extension into the Gonadal Vein, Uterus, Fallopian Tube, and Bilateral Ovaries: A Case Report.

Sarah E Sweigert,Petar Bajic,Alessa Aragao,Maria Picken,Michael E Woods

doi:10.15586/jkcvhl.2020.130

Sarah E Sweigert, Petar Bajic + Show 3 more

Open Access

https://doi.org/10.15586/jkcvhl.2020.130

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Abstract

Renal cell carcinoma (RCC) with invasion into the renal vein is well described; however, invasion into the gonadal vein is a rare event with less than five cases reported in the literature. RCC occasionally presents with metastasis to the ovaries or the fallopian tubes, although this is also a rare occurrence. We present a case of locally advanced left RCC with direct extension into the ipsilateral gonadal vein with extension into the bilateral ovaries and uterus, which has not been previously described. Computed tomography (CT) in a 72-year-old female with a 35-pound weight loss indicated the presence of a 16-cm left renal mass with caudal tumor extension through the left gonadal vein and regional lymphadenopathy. There was no evidence of distant metastasis, and she underwent an open left radical nephrectomy. Intraoperatively, she was found to have direct extension of the tumor through the left gonadal vein into the uterus, bilateral ovaries, and the left fallopian tube. All visible disease was resected, and retroperitoneal and pelvic lymphadenectomy were performed. The patient had an uneventful hospital course. Pathology revealed clear cell RCC, Fuhrman grade 3. The final pathologic stage was pT4N1M1. The patient was ultimately noted to have pulmonary metastasis and was treated with immunotherapy with no evidence of disease progression.

Highlights

With 403,262 annual cases around the world, kidney cancer is the sixth most common cancer diagnosis in the United States [1, 2]
No sarcomatoid or rhabdoid areas were noted. These findings rendered a diagnosis of left kidney clear cell Renal cell carcinoma (RCC), which extended into the renal vein, left ovarian vein and uterus, left fallopian tube, and bilateral ovaries (Figure 4)
There may have been an extension from the uterus to the ovary, or it may have been a result of hematogenous metastasis similar to the nodal disease noted at initial imaging and the distant pulmonary metastasis, which were discovered postoperatively

Summary

Introduction

With 403,262 annual cases around the world, kidney cancer is the sixth most common cancer diagnosis in the United States [1, 2]. There have been no reported cases of a RCC with extension into the gonadal vein with contiguous invasion into the bilateral ovaries, fallopian tube, and uterus. We present such a case with informed consent having been obtained from the patient. No sarcomatoid or rhabdoid areas were noted These findings rendered a diagnosis of left kidney clear cell RCC, which extended into the renal vein, left ovarian vein and uterus, left fallopian tube, and bilateral ovaries (Figure 4).

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