Ghanney Efe C, Cavallo Jaime A, Levin Matthew A, Reddy Ramachandra, Bander Jeffrey, Mella Maria, Stone Joanne, Schwartz Myron, Haines Kenneth, Gidwani Umesh, Mehrazin Reza
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Departments of Anesthesiology and Genomics and Genetic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ther Adv Urol. 2017 Apr 16;9(6):155-159. doi: 10.1177/1756287217701378. eCollection 2017 Dec.
Only one case of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus diagnosed and treated during pregnancy has been reported in the literature. In that report, the tumor thrombus extended to the infrahepatic IVC (level II tumor thrombus). In the present case, a 37-year-old woman with lupus anticoagulant antibodies was diagnosed with RCC and IVC tumor thrombus extending to the right atrium (level IV tumor thrombus) at 24 weeks of pregnancy. The fetus was safely delivered by cesarean section at 30 weeks of gestation. At 4 days later, an open right radical nephrectomy and IVC and right atrial thrombectomy were performed on cardiopulmonary bypass (CPB) once the patient's hemodynamic status had been optimized. Fetal and maternal concerns included the risk of a thromboembolic event (due to increased hypercoagulability from pregnancy, active malignancy, and lupus anticoagulant), intraoperative hemorrhage risk (due to extensive venous collaterals and anticoagulation), and fetal morbidity and mortality (due to fetal lung immaturity). Standardized guidelines for treatment of RCC with or without IVC tumor thrombus during pregnancy are unavailable due to the infrequency of such cases. Treatment decisions are therefore individualized and this case report may inform the management of future patients diagnosed with RCC with level IV tumor thrombus during pregnancy.
文献中仅报道过1例妊娠期诊断并治疗的伴有下腔静脉（IVC）瘤栓的肾细胞癌（RCC）。在该报道中，瘤栓延伸至肝下下腔静脉（Ⅱ级瘤栓）。在本病例中，一名患有狼疮抗凝抗体的37岁女性在妊娠24周时被诊断为RCC且IVC瘤栓延伸至右心房（Ⅳ级瘤栓）。妊娠30周时通过剖宫产安全娩出胎儿。4天后，在优化患者血流动力学状态后，在体外循环（CPB）下进行了开放性右肾癌根治术及IVC和右心房血栓切除术。胎儿和母亲的顾虑包括血栓栓塞事件的风险（由于妊娠、活跃的恶性肿瘤和狼疮抗凝导致的高凝状态增加）、术中出血风险（由于广泛的静脉侧支循环和抗凝）以及胎儿的发病率和死亡率（由于胎儿肺不成熟）。由于此类病例罕见，目前尚无关于妊娠期伴或不伴IVC瘤栓的RCC治疗的标准化指南。因此，治疗决策是个体化的，本病例报告可能为未来妊娠期诊断为Ⅳ级瘤栓的RCC患者的管理提供参考。
