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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (5): 928-932. doi: 10.19723/j.issn.1671-167X.2021.05.019

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Clinical and pathological features of renal cell carcinoma with urinary tract tumor thrombus: 6 cases report and literature review

TIAN Yu1,CHENG Xiao-yue2,HE Hui-ying3,WANG Guo-liang1,△(),MA Lu-lin1   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    3. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-04-06 Online:2021-10-18 Published:2021-10-11
  • Contact: Guo-liang WANG E-mail:wangguoliang@medmail.com.cn

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Abstract:

Objective: To investigate the clinical characteristics, diagnosis and treatment of renal cell carcinoma with urinary tract tumor thrombus. Methods: From January 1, 2015 to December 31, 2019, patients with renal cell carcinoma complicated with urinary tract tumor thrombus who were hospitalized in the Peking University Third Hospital and Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Meanwhile, we reviewed the literature, and the reported patients of renal cell carcinoma with urinary tract tumor thrombus were also included in our study. The basic information, clinical manifestations, treatment, pathological characteristics and follow-ups of all the patients were analyzed. Results: In our study, 6 patients from the two hospitals and 16 patients from previous literature reports were included. There were 13 males and 9 females with an average age of 54.7 years (22-79 years). Fifteen patients had renal cell carcinoma on the left side, 6 on the right side, and 1 on the unknown side. Gross hematuria was the most common chief complaint, including 18 patients. One patient complained of weight loss, 1 patient complained of microscopic hematuria, and 1 patient was found by ultrasound examination. Tumor thrombus was classified as grade Ⅰ in 9 cases (the tumor embolus protruded into the renal pelvis, but did not reach the ureteropelvic junction), grade Ⅱ in 10 cases (the tumor embolus protruded into the ureter, but not into the bladder), and grade Ⅲ in 3 cases (the tumor embolus passed through the ureter and protruded into the bladder). Only 11 patients were diagnosed with renal cell carcinoma before operation. Radical nephrectomy was performed in 9 cases and nephroureterectomy in 12 cases. In pathological diagnosis, there were 15 cases of clear cell renal cell carcinoma, 1 case of papillary renal cell carcinoma, 1 case of chromophobe cell carcinoma, 1 case of mixed cell renal cell carcinoma, 4 cases of renal cell carcinoma with undetermined classification. Eleven patients were followed up for 3-31 months, and 3 patients had lung metastasis within 6 months. Conclusion: Renal cell carcinoma with urinary tract tumor thrombus is rare in clinic. It needs to be differentiated from renal pelvis carcinoma in diagnosis. The treatment principle can refer to general renal carcinoma. For locally advanced cases, complete resection is the best treatment, and its oncological prognosis needs more long-term and large-scale follow-up observation.

Key words: Renal Cell Carcinoma, Urinary tract tumor thrombus, Neoplasm invasiveness

CLC Number: 

  • R737.11

Table 1

Clinical and pathological information of patients with renal cell carcinoma complicated with urinary tract tumor thrombus*"

Case Gender Age/
years		 Chief
complaint		 Tumor
thrombus
classification		 Preoperative
diagnosis		 Operation
method		 Histological
diagnosis		 WHO/ISUP
grade		 Follow-up
1 Male 53 Gross
hematuria		 Ⅰ Right RCC Open right radical
nephrectomy		 Clear cell RCC Ⅱ No recurrence or
metastasis for 16 months
2 Female 50 Weight loss Ⅱ Left RCC Laparoscopic left
radical nephrectomy		 Clear cell RCC Ⅲ No recurrence or
metastasis for 20 months
3 Male 70 Gross
hematuria		 Ⅱ Right RCC/RPC Laparoscopic right
nephroureterectomy		 RCC NA No recurrence or
metastasis for 31 months
4 Male 64 Gross
hematuria		 Ⅰ Left RCC Laparoscopic left
radical nephrectomy		 Clear cell RCC Ⅱ-Ⅲ Bilateral pulmonary nodules
before operation and
survival after 16 months
5 Male 63 Gross
hematuria		 Ⅰ Left RPC Laparoscopic left
nephroureterectomy		 Clear cell RCC Ⅲ No recurrence or
metastasis for 24 months
6 Male 61 Gross
hematuria		 Ⅱ Right RCC Laparoscopic right
radical nephrectomy		 Clear cell RCC Ⅱ Lung metastasis after
6 months and
survival after 18 months
7[1] Male 22 Right abdominal
pain with gross
hematuria		 Ⅱ Right RPC Right
nephroureterectomy		 Mixed RCC NA NA
8[2] Female 62 NA Ⅰ RPC NA RCC NA NA
9[3] Male 67 Gross
hematuria		 Ⅲ Left RPC,
bladder tumor		 Cystoscopy biopsy;
Open left
nephroureterectomy		 Clear cell RCC Ⅲ NA
10[4] Male 43 Gross
hematuria		 Ⅱ Left RCC Laparoscopic left
nephroureterectomy		 Clear cell RCC Ⅱ-Ⅲ NA
11[5] Male 64 Gross
hematuria		 Ⅰ Left RCC, right
adrenal metastasis		 Laparoscopic left
radical nephrectomy
and right
adrenalectomy		 Clear cell RCC Ⅱ NA
12[5] Female 77 Gross
hematuria		 Ⅰ Right RCC Laparoscopic right
radical nephrectomy		 Clear cell RCC Ⅳ NA
13[6] Female 58 Ultrasound
examination		 Ⅰ Left RPC Laparoscopic left
nephroureterectomy		 Clear cell RCC NA NA
14[7] Female 51 microscopic
hematuria		 Ⅲ Left RPC Left nephroureterectomy Clear cell RCC Ⅰ-Ⅱ Lung metastasis
after 6 months
15[8] Male 51 Right back
pain with
gross hematuria		 Ⅱ Right RCC Right ureteroscopy biopsy;
Open right radical
nephrectomy		 RCC NA No recurrence or
metastasis for 9 months
16[9] Female 47 Gross
hematuria		 Ⅰ Left RCC Open left
nephroureterectomy		 Chromophobe
RCC		 NA NA
17[10] Female 63 Gross
hematuria		 Ⅱ Left RCC Left radical
nephrectomy		 Clear cell RCC NA NA
18[11] Female 27 Gross
hematuria		 Ⅱ Left RPC Open left
nephroureterectomy		 RCC Ⅲ No recurrence or
metastasis for 3 months
19[12] Male 66 Gross
hematuria		 Ⅲ Left RPC Open left
nephroureterectomy		 Clear cell RCC NA Lung metastasis
after 5 months
20[13] Female 39 Left back pain
with gross
hematuria		 Ⅱ Left RPC Left nephroureterectomy Clear cell RCC Ⅲ NA
21[14] Male 79 Gross hematuria Ⅱ Left RCC Robot-assisted laparoscopy
left radical nephrectomy		 Clear cell RCC Ⅳ NA
22[15] Male 27 Gross hematuria Ⅰ Right RPC Laparoscopic right
nephroureterectomy		 Papillary RCC,
type Ⅰ		 NA No recurrence or
metastasis for 6 months

Figure 1

CT of 6 patients (cortical phase): the lesions showed inhomogeneous enhancement in cortical phase in Case 1, 2, 4, and 6, the enhancement degree was lower than that in renal parenchyma in Case 3 and 5"

Figure 2

Right nephroureterectomy specimen of Case 3 Figure 3 Histopathology of Case 3 3A, tumors prominent in the pelvis, HE ×20; 3B, HE ×100."

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