Tumor renal con situación en vena cava izquierda

Abstract

Malformation of the infrarenal segment of the vena cava is an uncommon abnormality with an incidence of approximately 0.005-1 % in the general population. It is usually asymptomatic. The presentation of this condition with symptoms secondary to thrombosis or collateral vessel hypertrophy is a rare clinical form and its association with a renal tumor is even rarer.We present herein the case of a 64-year-old man with a 12cm left renal tumor identified as renal clear cell carcinoma with locoregional extension, lymph node and ipsilateral adrenal gland involvement, a thrombus in the proximal vena cava, and pulmonary metastases (T4N1M1, clinical stage IV). The patient underwent radical nephrectomy, intraoperatively confirming the leftsided inferior vena cava containing a tumor thrombus previously seen in a tomography scan; the proximal segment of the inferior vena cava was also observed to be inside the tumor. Nephrectomy with vascular control and proximal thrombectomy of the vena cava was performed. The tumor thrombus was obtained through the Valsalva maneuver and the stump of the inferior vena cava was closed with two lines of 6-0 Prolene® double-armed sutures. A control angiotomography scan to evaluate the collateral venous blood flow was carried out and revealed rechanneling through the lumbar vessels. In the postoperative period, the patient was asymptomatic in relation to venous hypertension and swelling of the lower extremities.