CASE REPORT article
Front. Oncol.
Sec. Genitourinary Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1511980
EN BLOC RESECTION OF INFERIOR VENA CAVA AND RENAL CELL CARCINOMA WITH LEVEL IV TUMOR THROMBUS ASSOCIATED WITH TUMOR THROMBUS EMBOLIZATION TO THE PULMONARY ARTERIES: PRESENCE OF BLOOD VESSELS INSIDE THE TUMOR THROMBUS
Provisionally accepted
Juan Dugarte
Daniel H Buitrago
Ramona Nicolau RaducuJoshua P Raber
Hugo KanekuAngel Alvarez
Gaetano Ciancio*- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
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Background: Renal cell carcinoma (RCC) is an aggressive kidney cancer often diagnosed at an advanced stage. This type of kidney tumor can be associated with tumor thrombus (TT), which can extend into the inferior vena cava (IVC) and, in severe cases, into the right side of the heart. Managing RCC with TT is particularly complex when extension of the TT into the right heart is present, as the use of intraoperative transesophageal echocardiography (TEE) and cardiopulmonary bypass (CPB) aid in performing a complete TT surgical resection. In terms of tumor neo-vessels, solid tumors such as RCC-TT depend on a vascularized connective tissue stroma for growth, proliferation and malformation which are supported by various factors promoting these processes. Herein, we present the case of a 69-year-old patient with a right renal tumor with a TT extending through the IVC up into the right side of the heart. During the surgery, a segment of the TT embolized into the pulmonary arteries, highlighting the surgical challenges, the use of CPB, and TEE in managing such cases, as well as discussing the implications of finding blood vessels inside the TT.
Keywords: Renal cell carcinoma, Level IV tumor thrombus, en bloc resection, transesophageal echocardiography, Cardiopulmonary Bypass, Tumor thrombus
Received: 15 Oct 2024; Accepted: 18 Aug 2025.
Copyright: © 2025 Dugarte, Buitrago, Nicolau Raducu, Raber, Kaneku, Alvarez and Ciancio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gaetano Ciancio, Leonard M. Miller School of Medicine, University of Miami, Miami, 33136, Florida, United States
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