Upper Tract Urothelial Tumor with Renal Vein and Inferior Vena Cava Thrombus Case Report

Introduction: Urothelial tumors of upper tract are uncommon in clinical practice compared to other renal malignancy. Presentation of Case: A 71-year-old man with multiple co-morbidities who presented with generalized non-specific symptoms was worked up for his abnormal lab results. On imaging he was found to have an enlarged left kidney with perinephric fat stranding and inferior vena cava thrombus. Biopsy of the thrombus showed morphological features characteristic of malignant tumors with a papillary growth pattern. Preoperative diagnosis pointed towards Renal Cellular Carcinoma with IVC thrombus. The patient underwent left radical nephrectomy and IVC thrombectomy. Surgical pathology of the retrieved specimens showed high-grade urothelial (transitional cell) carcinoma of the renal pelvis with multiple lymph nodes and high-grade urothelial carcinoma and high-grade papillary urothelial carcinoma of the IVC thrombus, tumor stage (AJCC 7th edition): pT4b, N3, MX. Discussion: vascular involvement make small portion of renal malignancy but with urothelial origin make it more rare and few cases are reported in literature. Conclusion: To our knowledge this is the first reported case of upper tract urothelial cell carcinoma with IVC thrombus that mimics renal cell carcinoma in the Kingdom of Saudi Arabia and middle east.