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Tumor Thrombus
Journal of the American College of Cardiology Ó 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 61, No. 25, 2013 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2012.12.060
Tumor Thrombus Hector I. Michelena, MD,* John Stulak, MD,y Maurice Enriquez-Sarano, MD,* Stephen A. Boorjian, MDz Rochester, Minnesota
From the *Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; yDivision of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; and the zDepartment of Urology, Mayo Clinic, Rochester, Minnesota. Manuscript received December 4, 2012; accepted December 11, 2012.
48-year-old nonsmoking woman presented with acute epigastric pain after several months of nocturnal sweats. Computed tomography revealed a 9-cm right renal mass with venous tumor thrombus extending from the right renal vein to the right atrium, with no pulmonary embolism and no evidence of distant metastasis. Intraoperative transesophageal echocardiogram demonstrated an 8- 4-cm echogenic mass (TT) recoiling into the right atrium in systole (A, Online Video 1) and prolapsing into the right ventricle (RV) in diastole (B), with an intact tricuspid valve (Online Video 2). The mass prolapsed into the right ventricular outflow tract (RVOT) (C, Online Video 3) and originated at the inferior vena cava (IVC) (D, Online Video 4). The patient underwent right radical nephrectomy, lymph node dissection, resection/reconstruction of the suprarenal IVC with bovine pericardium, and cardiopulmonary bypass with hypothermic circulatory arrest to facilitate extraction of a 21- 5- 2-cm tumor thrombus via right atriotomy (E, F). Pathology demonstrated grade 4 clear cell renal cell carcinoma with negative lymph nodes and negative surgical margins. The patient recovered uneventfully and was free of disease at 3 months. IVC tumor thrombus complicates 5% to 10% of renal cell carcinoma cases and does not necessarily imply a dismal prognosis if nodal and distant metastasis are not present, with a 5-year cancer-specific survival approaching 60%. LA ¼ left atrium; LV ¼ left ventricle.
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Vol. 61, No. 25, 2013 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2012.12.060
Tumor Thrombus Hector I. Michelena, MD,* John Stulak, MD,y Maurice Enriquez-Sarano, MD,* Stephen A. Boorjian, MDz Rochester, Minnesota
From the *Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; yDivision of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; and the zDepartment of Urology, Mayo Clinic, Rochester, Minnesota. Manuscript received December 4, 2012; accepted December 11, 2012.
48-year-old nonsmoking woman presented with acute epigastric pain after several months of nocturnal sweats. Computed tomography revealed a 9-cm right renal mass with venous tumor thrombus extending from the right renal vein to the right atrium, with no pulmonary embolism and no evidence of distant metastasis. Intraoperative transesophageal echocardiogram demonstrated an 8- 4-cm echogenic mass (TT) recoiling into the right atrium in systole (A, Online Video 1) and prolapsing into the right ventricle (RV) in diastole (B), with an intact tricuspid valve (Online Video 2). The mass prolapsed into the right ventricular outflow tract (RVOT) (C, Online Video 3) and originated at the inferior vena cava (IVC) (D, Online Video 4). The patient underwent right radical nephrectomy, lymph node dissection, resection/reconstruction of the suprarenal IVC with bovine pericardium, and cardiopulmonary bypass with hypothermic circulatory arrest to facilitate extraction of a 21- 5- 2-cm tumor thrombus via right atriotomy (E, F). Pathology demonstrated grade 4 clear cell renal cell carcinoma with negative lymph nodes and negative surgical margins. The patient recovered uneventfully and was free of disease at 3 months. IVC tumor thrombus complicates 5% to 10% of renal cell carcinoma cases and does not necessarily imply a dismal prognosis if nodal and distant metastasis are not present, with a 5-year cancer-specific survival approaching 60%. LA ¼ left atrium; LV ¼ left ventricle.
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