Proteinuria in a Patient with Transitional Cell Carcinoma of Renal Pelvis with Extension into Inferior Vena Cave

Transitional cell carcinoma (TCC) of the renal pelvis and upper uncommon, accounting for only 7% of all primary tumors of the kidney. Tumor thrombus of transitional cell carcinoma invading reported. Gross hematuria is the most common symptom in these documented cases, followed by flank pain. Besides episodic hematuria and flank pain, the persistent foamy and cloudy urine, initially noticed by our patient, was disclosed to be heavy proteinuria after laboratory tests. Renal ultrasonography and subsequent computerized tomography (CT) showed a huge tumor occupying the right renal pelvis with a suspicious thrombus in the inferior vena cava. Under the impression of renal cell carcinoma, right radical nephrectomy with vena cava thrombectomy was perfomed. The final pathological diagnosis was transitional cell carcinoma with an inferior vena cava thrombus. The prognosis for such patients is relatively poor in the previous reports, only 60% of them surviving longer than six months with or without adjuvant chemotherapy. In our case, hematuria, flank pain, proteinuria all disappeared spontaneously two weeks after tumor rmoval and, without adjuvant chemotherapy, no obvious recurrence was observed during the follow up for twelve months. In clinical practice, physicians should be alerted by heavy proteinuria with gross hematuria and/or flank pain and consider TCC with invasion of the vena cava as one of the possible differential diagnosis.