Symptoms and clinical course of renal cell carcinoma, complicated by implantation thrombosis of the renal vein and inferior vena cava

Abstract

Introduction. The peculiarity of the clinical course of renal cell carcinoma is its propensity to venous distribution with the formation of a implantation thrombus in the renal vein or inferior vena cava. Symptoms of this process are not clearly described in the literature. The aim of the study. On the basis of the study of the clinical course of RCC, which is complicated by implantation thrombosis of the renal vein and IVC, to determine the symptoms of the disease associated with the formation of obstruction of the IVC. Results. The overall condition of patients on the ECOG scale was as follows: 0 points were found in 83 (65.4%) patients, 1 in 39 (30.7%) and 2 in 5 (3.9%). Levels of distribution of tumorous thrombus by IVC were determined by the classification of the Meyo clinic: the zero level was 50 (39.4%) patients, I level – 26 (20.5%), ІІ level – 27 (21.2%), ІІІ level – 18 (14.2%) and IV level – 6 (4.7%). In 9 (7.1%) patients, in addition to tumorous thrombosis IVC, phlebotrombosis of the femur, iliac veins and IVC was diagnosed. In 32 (25.2%) patients, any symptoms were absent, and the detection of kidney tumors and tumorous venous thrombus was an accidental finding during an ultrasound examination or computer tomography for other diseases. Clinical symptoms were detected in 95 (74.8%) patients. The most common symptoms were the clinical manifestations of local tumor spread in the form of pain in the lumbar region or abdomen (44.9%) and macrohematuria (33.9%). Symptoms of cancer intoxication as general weakness were found in 22.8% of cases. The symptoms of compression or obstruction of the IVC in the form of right-sided varicocele were recorded in only one (0.8%) patient. Edema of the legs (increase in the volume of the legs more than 3 cm) was diagnosed in 9 (7.1%) patients, 6 of which were cyanosis of the legs. These were patients who, in addition to tumorous thrombosis, had a concomitant pathology in the form of phlebothrombosis of the femur, iliac veins and IVC. Conclusion. In 25.2% patients of RCC, complicated by implantation thrombosis of the renal vein and IVC has asymptomatic course and the detection of kidney tumors and tumor venous thrombus in them is a coincidence finding during an ultrasound examination or computer tomography for other diseases. In this regard, patients with renal cancer should be obliged to perform ultrasound and X-ray examination of IVC for the purpose of detecting implantation thrombus. The presence of concomitant phlebotrombosis of the of the femur, iliac veins and IVC should not be considered as a symptom, and complication of implantation thrombosis IVC.