右側腎盂分化不良變異型尿路上皮癌合併下腔靜脈血栓～
以達文西機械手臂輔助切除右腎、輸尿管及下腔靜脈血栓
王志仁、余家政
高雄榮民總醫院 外科部 泌尿外科 移植外科
Robot-assisted nephroureterectomy with IVC thrombectomy for
poorly differentiated variant of urothelial carcinoma of right kidney
Chih-Jen Wang, Chia-Cheng Yu
Division of Urology and Transplant Surgery, Department of Surgery
Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Urothelial carcinoma of the renal pelvis with renal vein and inferior vena cava (IVC) tumor thrombus is extremely rare. We report a 58-year-old female who suffered from left chest pain initially. She was misdiagnosed as non-small cell lung cancer and underwent systemic chemotherapy elsewhere. Gross hematuria developed later. Abdominal CT and renal MRI disclosed diffusely infiltrating right renal tumor with right renal vein and level II IVC thrombus. We performed robot-assisted palliative nephroureterectomy with bladder cuff excision and IVC thrombectomy. The peri- and post-operative periods were uneventful. The final pathology was poorly differentiated variant of urothelial carcinoma with invasion to renal parenchyma, renal vein and IVC.
We would like to share this unusual variant of urothelial carcinoma with even rare IVC tumor thrombus and the feasibility of robotic IVC thrombectomy. The associated literatures are also reviewed.