Li Mingyang, Shi An, Kong Wen, Zhang Jin, Chen Yonghui, Huang Jiwei, Huang Yiran
Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
World J Surg Oncol. 2016 Dec 28;14(1):309. doi: 10.1186/s12957-016-1041-z.
Transitional cell carcinoma (TCC) originating from the renal pelvis with a venous tumor thrombus is a rare entity. However, clinicians should be aware of it because of its high malignancy and poor prognosis.
Here, we report three cases of pathologically confirmed TCC originating from the renal pelvis with extension into the renal vein or inferior vena cava (IVC). Of these patients, two are males and one is female (58~73 years old). Their main symptom is flank pain; besides, gross hematuria and weight loss is observed in one of the patients. Computed tomography (CT) scan of the first patient revealed multiple space-occupying lesions in the left renal pelvis and left medium and lower ureter with a tumor thrombus in the left renal vein. CT scan of the second patient revealed a right renal mass and extension into the IVC. Abdominal magnetic resonance imaging (MRI) of the third patient showed a soft tissue mass in the region of the left renal sinus, and the signal of the soft tissue was observed in the left renal vein. The preoperative diagnoses of the first and third patient were TCC, while the second patient was renal cell carcinoma (RCC). Two patients with the preoperative diagnosis of TCC underwent laparoscopic radical nephroureterectomy with thrombectomy, and the other patient underwent radical nephrectomy with thrombectomy. The surgeries were successful. Although two of our patients underwent chemotherapy and radiotherapy, they died 2 and 19 months after the surgery, respectively. The other patient refused any adjuvant therapy and died 3 months after the operation.
Compared to the extension of RCC to the renal vein or IVC, extension of TCC to the renal vein or IVC is rare. TCC with a venous tumor thrombus is often misdiagnosed as RCC. However, a correct preoperative or intraoperative diagnosis is of great importance to decide surgical strategy. Laparoscopic radical nephroureterectomy with thrombectomy may be a safe and feasible operative method in treatment of TCC with a renal vein thrombus. The prognosis of such cases is poor even if chemotherapy and radiotherapy are scheduled.
起源于肾盂并伴有静脉瘤栓的移行细胞癌（TCC）是一种罕见的疾病。然而，由于其高恶性和预后不良，临床医生应予以关注。
在此，我们报告3例经病理证实的起源于肾盂并延伸至肾静脉或下腔静脉（IVC）的TCC。这些患者中，2例为男性，1例为女性（58至73岁）。他们的主要症状是胁腹痛；此外，其中1例患者还出现肉眼血尿和体重减轻。第1例患者的计算机断层扫描（CT）显示左肾盂及左输尿管中下段有多个占位性病变，左肾静脉有肿瘤栓子。第2例患者的CT扫描显示右肾肿块并延伸至IVC。第3例患者的腹部磁共振成像（MRI）显示左肾窦区域有软组织肿块，左肾静脉可见软组织信号。第1例和第3例患者的术前诊断为TCC，而第2例患者为肾细胞癌（RCC）。2例术前诊断为TCC的患者接受了腹腔镜根治性肾输尿管切除术并取栓，另1例患者接受了根治性肾切除术并取栓。手术均成功。尽管我们的2例患者接受了化疗和放疗，但分别在术后2个月和19个月死亡。另1例患者拒绝任何辅助治疗，术后3个月死亡。
与RCC延伸至肾静脉或IVC相比，TCC延伸至肾静脉或IVC较为罕见。伴有静脉瘤栓的TCC常被误诊为RCC。然而，正确的术前或术中诊断对于决定手术策略至关重要。腹腔镜根治性肾输尿管切除术并取栓可能是治疗伴有肾静脉血栓的TCC的一种安全可行的手术方法。即使安排了化疗和放疗，此类病例的预后也很差。
