Renal cell carcinoma extending into the retrohepatic inferior vena cava.

A 69-year-old woman presented with hematuria. Magnetic resonance imaging revealed a left renal mass extending into the retrohepatic inferior vena cava (IVC) (Figs. 1 and ​and2).2). Both magnetic resonance imaging of the brain and a bone scan were negative for distant metastases. Intraoperatively, the IVC was cross-clamped below the level of the hepatic veins to prevent dissemination of the intracaval part of the tumor. Left radical nephrectomy and resection of the intracaval part of the tumor mass were successfully performed. The IVC was repaired primarily. The patient tolerated the procedure well and was discharged from the hospital on the 9th postoperative day. The histopathologic report showed papillary renal cell carcinoma, Fuhrman nuclear grade 3 (Figs. 3 and ​and44). Fig. 1 Magnetic resonance image of the abdomen shows a large tumor mass (arrows) originating from the left kidney and extending into the retrohepatic portion of the inferior vena cava. Fig. 2 Magnetic resonance image of the abdomen shows the intracaval part (arrow) of the tumor mass. Fig. 3 Photomicrograph of the resected specimen shows the complex papillary formation of the tumor cells. Note that the fibrovascular papillary stalks are lined by a single layer of cuboidal/columnar cells characterized by low-grade nuclear cytology and eosinophilic ... Fig. 4 Photomicrograph of the resected specimen shows tumor thrombus (TT), renal vein lumen (RL), and renal vein wall (RW) (H & E, orig. ×100).