Samlowski Erika E, Dechet Christopher, Weissman Alan, Samlowski Wolfram E
Nevada Cancer Institute, One Breakthrough Way, Las Vegas, NV 89135, USA.
J Med Case Rep. 2011 Jun 28;5:245. doi: 10.1186/1752-1947-5-245.
Many cancers are associated with inferior vena cava (IVC) obstruction, but very few cancers have the ability to propagate within the lumen of the renal vein or the IVC. Renal cell carcinoma is the most common of these cancers. Renal cancer with IVC extension has a high rate of recurrence and a low five year survival rate.
A 62-year-old Caucasian woman previously in good health developed the sudden onset of severe reflux symptoms and right-sided abdominal pain that radiated around the right flank. A subsequent ultrasound and CT scan revealed a right upper pole renal mass with invasion of the right adrenal gland, liver, left renal vein and IVC. This appeared to be consistent with stage III renal cancer with IVC extension. Metastatic nodules were believed to be present in the right pericardial region; the superficial anterior abdominal wall; the left perirenal, abdominal and pelvic regions; and the left adrenal gland. The pattern of these metastases, as well as the invasion of the liver by the tumor, was thought to be atypical of renal cancer. A needle biopsy of a superficial abdominal wall mass revealed a surprising finding: The malignant cells were diagnostic of large-cell, B-cell non-Hodgkin's lymphoma. The lymphoma responded dramatically to systemic chemotherapy, which avoided the need for nephrectomy.
Lymphomas only rarely progress via intraluminal vascular extension. We have been able to identify only one other case report of renal lymphoma with renal vein and IVC extension. While renal cancer would have been treated with radical nephrectomy and tumor embolectomy, large-cell B-cell lymphomas are treated primarily with chemotherapy, and nephrectomy would have been detrimental. It is important to remember that, rarely, other types of cancer arise from the kidney which are not derived from the renal tubular epithelium. These may be suspected if an atypical pattern of metastases or unusual invasion of surrounding organs is present. A preoperative or intraoperative biopsy may be helpful in these cases.
许多癌症与下腔静脉（IVC）梗阻有关，但很少有癌症能够在肾静脉或下腔静脉腔内扩散。肾细胞癌是这些癌症中最常见的。伴有IVC延伸的肾癌复发率高，五年生存率低。
一名62岁身体健康的白种女性突然出现严重的反流症状和右侧腹痛，并放射至右胁腹周围。随后的超声和CT扫描显示右肾上极有一肾肿块，侵犯了右肾上腺、肝脏、左肾静脉和下腔静脉。这似乎符合伴有IVC延伸的III期肾癌。据信右心包区域、腹前壁浅表、左肾周、腹部和盆腔区域以及左肾上腺有转移结节。这些转移灶的模式以及肿瘤对肝脏的侵犯被认为是非典型的肾癌表现。对腹前壁浅表肿块进行针吸活检发现了一个惊人的结果：恶性细胞诊断为大细胞B细胞非霍奇金淋巴瘤。该淋巴瘤对全身化疗反应显著，从而避免了肾切除术的需要。
淋巴瘤很少通过腔内血管延伸进展。我们仅能找到另一例肾淋巴瘤伴有肾静脉和IVC延伸的病例报告。如果是肾癌，通常会采用根治性肾切除术和肿瘤栓子切除术，而大细胞B细胞淋巴瘤主要采用化疗，肾切除术可能有害。重要的是要记住，很少有其他类型的癌症起源于肾脏且并非源自肾小管上皮。如果存在非典型的转移模式或对周围器官的异常侵犯，则可能怀疑是这些癌症。在这些情况下，术前或术中活检可能会有所帮助。
