Renal Cell Carcinoma with Direct Extension into the Gonadal Vein, Uterus, Fallopian Tube, and Bilateral Ovaries: A Case Report

Main Article Content

Sarah E. Sweigert
Petar Bajic
Alessa Aragao
Maria Picken
Michael E. Woods

Keywords

Abstract

Renal cell carcinoma (RCC) with invasion into the renal vein is well described; however, invasion into the gonadal vein is a rare event with less than five cases reported in the literature. RCC occasionally presents with metastasis to the ovaries or the fallopian tubes, although this is also a rare occurrence. We present a case of locally advanced left RCC with direct extension into the ipsilateral gonadal vein with extension into the bilateral ovaries and uterus, which has not been previously described. Computed tomography (CT) in a 72-year-old female with a 35-pound weight loss indicated the presence of a 16-cm left renal mass with caudal tumor extension through the left gonadal vein and regional lymph-adenopathy. There was no evidence of distant metastasis, and she underwent an open left radical nephrectomy. Intraoperatively, she was found to have direct extension of the tumor through the left gonadal vein into the uterus, bilateral ovaries, and the left fallopian tube. All visible dis-ease was resected, and retroperitoneal and pelvic lymphadenectomy were performed. The patient had an uneventful hospital course. Pathology revealed clear cell RCC, Fuhrman grade 3. The final pathologic stage was pT4N1M1. The patient was ultimately noted to have pulmonary metastasis and was treated with immunotherapy with no evidence of disease progression.

Abstract 1870 | PDF Downloads 1003 HTML Downloads 423 XML Downloads 447

References

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi. org/10.3322/caac.21492
2. American Cancer Society. Cancer facts & figures 2019. Atlanta, GA: American Cancer Society; 2019.
3. Chow W-H, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer. Nat Rev Urol. 2010;7(5):245–57. https:// doi.org/10.1038/nrurol.2010.46
4. Ghersin E, Leiderman M, et al. Renal cell carcinoma invading the right ovarian vein: Multidetector computed tomography and ultrasound Doppler findings. J Comp Assist Tomogr. 2005;29(4):472–4. https://doi.org/10.1097/01.rct.0000164514. 31030.d7
5. Goyal A, Rangarajan K, et al. Role of imaging in successful management of malignant ovarian vein thrombosis in RCC. BMJ Case Rep. 2014;7:201576. http://dx.doi.org/10.1136/ bcr-2013-201576
6. Haghighatkhah H, Karimi MA, et al. Gonadal vein tumor thrombosis due to renal cell carcinoma. Indian J Urol. 2015;31(1):79–80. https://doi.org/10.4103/0970-1591.139553
7. Kelvin FM. Invasion of the gonadal vein in renal cell carcinoma. Br J Radiol. 1975;48(568):315–16. https://doi. org/10.1259/0007-1285-48-568-315
8. Komatsubara M, Yamazaki M, et al. 2016. Tumor thrombus of renal cell carcinoma extending into the inferior Vena Cava, ovarian vein, and ureter treated with neoadjuvant axitinib. Urology. 1975;95(September):e3–4. https://doi.org/10.1016/j. urology.2016.05.057
9. Narayan R, Ravishankar U, et al. 18F-Fluorodeoxyglucose positron emission tomography-computed tomography finding of left gonadal vein thrombosis in a case of renal cell carcinoma. Indian J Nucl Med. 2016;31(3):238–39. https://doi. org/10.4103/0972-3919.183607
10. Thomas AA, Herts BR, et al. Gonadal vein tumor thrombus in metastatic renal cell carcinoma. Urology. 2009;73(6):1229–30. https://doi.org/10.1016/j.urology.2008.11.020
11. Liang L, Huang H, et al. Renal cell carcinoma metastatic to the ovary or fallopian tube: A clinicopathological study of 9 cases. Hum Pathol. 2016;51(May):96–102. https://doi.org/10.1016/j. humpath.2015.12.017
12. Uruc F, Akan S, et al. Contralateral ovarian metastasis of clear-cell renal carcinoma: A rare case report and review of the literature. Case Rep Surg. 2017;2017:9849205. https://doi. org/10.1155/2017/9849205
13. Delahunt B, Cheville JC, et al. The international society of urological pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol. 2013;37(10):1490–504. https://doi.org/10.1097/ PAS.0b013e318299f0fb
14. Mulcahy JJ, Furlow WL. Vaginal metastasis from renal cell carcinoma: Radiographic evidence of possible route of spread. J Urol. 1970;104(1):50–2. https://doi.org/10.1016/S0022-5347(17)61669-0