case_images: PMC10758900_01
case_images: Imaging manifestations of renal cancer, the IVC thrombus, and the fourth rib metastases. (a-c) Computed tomography before systemic therapy. (d, e) MRI before surgery. (f-h) Computed tomography before systemic therapy. (i, j) MRI before surgery. The yellow arrows denote the blood flow between the IVC wall and thrombus, and the green arrows denote the absence of blood flow between the wall and the advanced portion.
case_images: IJU5-7-60-g002.jpg
case_images: PMC10758900_01_IJU5-7-60-g002.jpg
case_images: iju512668-fig-0001
case_images: Ciancio's classification (Fig. 1a-c). Cine MRI, an imaging method that specializes in capturing the motions of objects, revealed some blood flow between the IVC wall and the body of the thrombus but no mobility or blood flow between the IVC wall and the advanced portion of the tumor, indicating the possibility of adhesion to or invasion of the IVC wall (Fig. 1d,e). The patient was treated with pembrolizumab every 3 weeks and lenvatinib every day for 6 months, resulting in tumor shrinkage (Fig. 1f-h). The findings on preoperative cine MRI were similar to those before systemic therapy, including some blood flow between the IVC wall and the thrombus but no mobility or blood flow between the wall and advanced portion (Fig. 1g,i).
case_images: Pathological examination of ccRCC. (a) HE staining (x4) of the renal biopsy specimen prior to systemic therapy. (b) HE staining (x4) of the tumorous area of the resected specimen. (c) HE staining (x10) of the advanced portion of the thrombus in the surgically resected specimens. The yellow arrows denote inflammatory cell infiltration, the green arrows denote ccRCC, the red arrows denote the necrotic area of the tumor, and the blue arrow denotes the IVC wall.
case_images: IJU5-7-60-g001.jpg
case_images: PMC10758900_01_IJU5-7-60-g001.jpg
case_images: iju512668-fig-0002