Renal cell carcinoma with tumour thrombus extending in duplicated inferior vena cava: A rarity with management conundrum

Abstract

DIVC may play a role as a confounding factor in imaging diagnostic tests and also may represent a hazard for inadvertent injury and bleeding during surgery. Careful interpretation Radiological investigations help to define such anomalies and avoid significant morbidity during surgical exploration. We present a case of renal cell carcinoma involving Right kidney with tumor thrombus extending into both venae cava. Triphasic Contrast-Enhanced Computerized Tomography (CECT) scan of abdomen with three-dimensional reconstruction showed duplicated left sided IVC, Heterogeneously enhancing intraluminal soft tissue density filling defect was seen along the entire length of right renal vein, also crossing the midline to the left sided duplicated IVC -s/o tumour thrombus. Patient underwent right radical nephrectomy with tumour thrombectomy. Cavotomy was done at the junction of right renal vein and right IVC. Entire thrombus was delivered intact. Histopathological examination showed papillary renal cell carcinoma (type II) stage pT3bN1Mx. IVC thrombus showed clusters of malignant cells of same morphology as tumor entangled in thrombus. The patient is doing well at 3 months of follow-up.