title: Transitional cell carcinoma with extension of the renal vein and IVC tumor thrombus: report of three cases and literature review.
abstract: BACKGROUND
  Transitional cell carcinoma (TCC) originating from the renal pelvis with a venous tumor thrombus is a rare entity. However, clinicians should be aware of it because of its high malignancy and poor prognosis.
  
  
  METHODS
  Here, we report three cases of pathologically confirmed TCC originating from the renal pelvis with extension into the renal vein or inferior vena cava (IVC). Of these patients, two are males and one is female (58~73 years old). Their main symptom is flank pain; besides, gross hematuria and weight loss is observed in one of the patients. Computed tomography (CT) scan of the first patient revealed multiple space-occupying lesions in the left renal pelvis and left medium and lower ureter with a tumor thrombus in the left renal vein. CT scan of the second patient revealed a right renal mass and extension into the IVC. Abdominal magnetic resonance imaging (MRI) of the third patient showed a soft tissue mass in the region of the left renal sinus, and the signal of the soft tissue was observed in the left renal vein. The preoperative diagnoses of the first and third patient were TCC, while the second patient was renal cell carcinoma (RCC). Two patients with the preoperative diagnosis of TCC underwent laparoscopic radical nephroureterectomy with thrombectomy, and the other patient underwent radical nephrectomy with thrombectomy. The surgeries were successful. Although two of our patients underwent chemotherapy and radiotherapy, they died 2 and 19 months after the surgery, respectively. The other patient refused any adjuvant therapy and died 3 months after the operation.
  
  
  CONCLUSIONS
  Compared to the extension of RCC to the renal vein or IVC, extension of TCC to the renal vein or IVC is rare. TCC with a venous tumor thrombus is often misdiagnosed as RCC. However, a correct preoperative or intraoperative diagnosis is of great importance to decide surgical strategy. Laparoscopic radical nephroureterectomy with thrombectomy may be a safe and feasible operative method in treatment of TCC with a renal vein thrombus. The prognosis of such cases is poor even if chemotherapy and radiotherapy are scheduled.
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
authors.forename: Mingyang
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
authors.forename: An
authors.initials: A
authors.lastname: Shi
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Kong
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China. jiweihuang@outlook.com.
authors.forename: Jiwei
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai, 200127, China. yrhuangrenji@163.com.
authors.forename: Yiran
authors.identifier: http://orcid.org/0000-0001-6839-952X
authors.initials: Y
authors.lastname: Huang
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis*; D002295:Carcinoma, Transitional Cell / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D000072226:Computed Tomography Angiography; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D021501:Flank Pain / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009392:Nephrectomy; D011379:Prognosis; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D017131:Thrombectomy; D014513:Ureter / Q000601:surgery; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D020246:Venous Thrombosis / Q000150:complications / Q000601:surgery*
keywords: Renal pelvic tumor; Transitional cell carcinoma; Tumor thrombus