Advanced Renal Cell Carcinoma with Extensive Venous Tumor Thrombus: A Case Report

Background Renal cell carcinoma (RCC) is an aggressive cancer that can invade into the renal vein and inferior vena cava (IVC), rarely with extension into the right atrium resulting in life-threatening complications such as thrombus migration into the pulmonary arteries and sudden cardiac death. Case presentation This is a single patient case report describing a multidisciplinary approach to a 59-year-old Bangladeshi male with type 2 diabetes mellitus and osteoarthritis presenting with progressive fatigue, intermittent left-sided abdominal discomfort, early satiety, a 6-kg unintentional weight loss, mild nausea, and gradually worsening bilateral ankle swelling. An initial investigation revealed moderate normocytic anemia with normal endoscopy and colonoscopy. Further investigations included Ultrasound of the abdomen with Doppler Ultrasonography which demonstrated a large, heterogeneous mass occupying the mid-to-lower pole of the left kidney with distended left renal vein, mild ascites and hepatic vein congestion. A subsequent contrast-enhanced CT scan of the abdomen and pelvis revealed the contiguity of tumor thrombus into the IVC with projection into the right atrium. Transthoracic echocardiography confirmed the diagnosis furthermore. On physical examination, abdomen was distended with left flank tenderness, and a palpable mass in the upper left quadrant. A CT-guided percutaneous biopsy of the renal mass revealed clear cell RCC. Based on clinical and imaging results, we diagnosed the patient as a case of advanced renal cell carcinoma with extensive venous tumor thrombus extending into the right atrium. Due to the advancement of cancer and involvement of the vascular structures, we opted for conservative management with long-term therapeutic anticoagulation and combination immune checkpoint therapy. Conclusion This case highlights the diagnostic strategies of advanced RCC in resource limited settings which facilitates earlier diagnosis and improves outcomes of such cases.