A 72-year-old male smoker of 60 cigarettes/day, with a history of bronchial hyperreactivity, cervical lumbar arthrosis.
After the study of swelling and pain in both lower extremities, Doppler ultrasound of the lower limbs was performed, reporting bilateral deep vein thrombosis.
In the study of abdominal-pelvic CT, a heterogeneous right renal lesion was observed that seemed to depend on the pelvis, poorly defined, with involvement of the vena cava, renal vein, and right trabeculation muscle, as well.
Light excretory phase.
Thromb in the inferior vena cava and both iliacs.
Retroperitoneal adenopathies smaller than 1 cm.
1.
Abdominal MR angiography showed hypoplasia of the intrahepatic segment of the inferior vena cava with significant collateral circulation through the azygos and hemiazygos veins.
Right renal tumor extending to soft tissues with retrocaval lymphadenopathy displacing the inferior vena cava to the inferior vena cava compressed and left it in front of a thickened caliber.
3 diagnosis of retroperitoneal carcinoma was suspected by means of right subperitoneal laparotomy in which a large right renal tumor and vascular structures were observed together with an adjacent abdominal vena cava (colon angle, 3rd duodenal patch).
The macroscopic description of the pathological study highlighted a nephrectomy specimen of 8 x 5 cm, observing a firm greyish diffuse tumor measuring 5 cm in diameter and extending to perirenal fat.
On the other hand, microscopic description revealed a malignant neoplasm formed by epithelial cells and ductal structures.
These structures showed strong positivity for keratin 34 BE
It invaded the wall of the renal vein, reaching the surgical edge.
Metastasis in two lymph nodes
Thus, the definitive diagnosis of collecting duct carcinoma with involvement of the surgical margin, renal vein and lymphatic dissemination was established.
The patient died due to multiple organ failure on the third postoperative day.
