Tumores renales bilaterales sincrónicos de células claras con trombo tumoral bilateral, reporte de caso

Abstract

IntroductionRenal cell carcinoma represents 2%-3% of malignant tumours, with 1.8%-11% of cases being bilateral, and 4%-15% associated with tumour thrombus in the renal vein or inferior vena cava. A report is presented on a patient with bilateral synchronous renal tumours and bilateral tumour thrombus. To our knowledge, this is the first reported case with these characteristics. Materials and methodsA case report of bilateral synchronous renal tumours in a 46 year-old woman with a left 15cm tumour including necrosis and ipsilateral tumour thrombus compromising the renal vein and the inferior vena cava (Level II). She also had a 5cm right renal tumor, 100% endophytic, in the superior renal pole with level I tumour thrombus.A left radical nephrectomy with thrombectomy was performed, as well as inferior vena cava repair plus retroperitoneal lymphadenectomy. A right partial nephrectomy with renal vein thrombectomy was then performed in a second operation that required intraoperative ultrasound. ResultsThere was a satisfactory recovery after surgery. The final pathology reported the left kidney with a clear renal cell carcinoma, Fuhrman 3, vascular invasion, negative margins, negative retroperitoneal, and iliac nodes. The right kidney with clear renal cell carcinoma, vascular invasion, negative margins, and Fuhrman 2.After 8 months of follow-up, the patient is free of recurrence with normal renal function. ConclusionsDespite the morbidity and mortality associated with synchronous renal carcinoma with bilateral tumour thrombus, it is possible to achieve adequate oncological control with surgical treatment, preserving the renal function.