Tsukada Hikaru, Hayakawa Nozomi, Aida Koichiro, Wada Shinji, Morimoto Tsuyoshi, Doi Masatomo, Mimura Hidefumi, Koike Junki, Kikuchi Eiji
Department of Urology St. Marianna University School of Medicine Kawasaki Japan.
Department of Diagnostic and Interventional Radiology St. Marianna University School of Medicine Kawasaki Japan.
IJU Case Rep. 2023 Nov 1;7(2):91-94. doi: 10.1002/iju5.12662. eCollection 2024 Mar.
Up to 10% of patients with renal cell carcinoma present with tumor thrombus in the inferior vena cava. We report that a case of small renal cell carcinoma with tumor thrombus extending above the diaphragm for which transvenous biopsy was performed for diagnosis.
A 79-year-old man performed computed tomography to evaluate hepatic dysfunction, which revealed intravenous tumor extending above the diaphragm and a 15-mm-sized exophytic tumor in right kidney. Imaging suggested that the renal tumor was renal cell carcinoma. As this tumor was small and exophytic, confirmation of the intravenous tumor being tumor thrombus associated with renal cell carcinoma was difficult. We simultaneously performed transvenous biopsy on the intravenous tumor and percutaneous biopsy on the renal tumor for obtaining histologic diagnoses. The final diagnosis was small renal cell carcinoma accompanied by tumor thrombus above the diaphragm.
Transvenous biopsy may be useful for the definitive diagnosis of inferior vena cava-tumor thrombus in cases of small renal cell carcinoma.
高达10%的肾细胞癌患者存在下腔静脉肿瘤血栓。我们报告一例小肾细胞癌伴有肿瘤血栓延伸至膈肌上方，为此进行了经静脉活检以明确诊断。
一名79岁男性因评估肝功能进行计算机断层扫描，结果显示静脉内肿瘤延伸至膈肌上方，右肾有一个15毫米大小的外生性肿瘤。影像学检查提示肾肿瘤为肾细胞癌。由于该肿瘤较小且为外生性，难以确定静脉内肿瘤是否为与肾细胞癌相关的肿瘤血栓。我们同时对静脉内肿瘤进行了经静脉活检，并对肾肿瘤进行了经皮活检以获得组织学诊断。最终诊断为小肾细胞癌伴膈肌上方肿瘤血栓。
经静脉活检对于小肾细胞癌病例中下腔静脉肿瘤血栓的明确诊断可能有用。
