Renal cell carcinoma (RCC) during pregnancy is rare, and the treatment of this condition requires appropriate steps to treat both the patient and the fetus. To the best of our knowledge, this is the first report to describe a case of RCC with tumor thrombus in the inferior vena cava (IVC) occurring during pregnancy. The affected 46-year-old pregnant woman with placenta previa was clinically diagnosed with cT3bN0M0 RCC at 25 weeks gestation. Therapeutic considerations included risk of sudden pulmonary embolism, risk of thrombosis or intraoperative hemorrhage, and safe delivery of the fetus. After extensive consultation with obstetricians and pediatricians, the surgical management was divided into two steps. First, the patient underwent Caesarean section and simultaneous hysterectomy at 26 weeks gestation. Then, 16 days after delivery, when hemodynamics and hemostasis had improved due to termination of gestation, the patient underwent radical nephrectomy with concomitant IVC thrombectomy.

Keywords:
Renal cell carcinoma, Inferior vena cava tumor thrombus, Pregnancy
1.
Brenner B, Avivi I: Cancer in pregnancy: the role of thromboprophylaxis. Thromb Res 2012;129(suppl 1):S20-S21.
2.
Bhutta HY, Walsh SR, Tang TY, Walsh CA, Clarke JM: Ovarian vein syndrome: a review. Int J Surg 2009;7:516-520.
3.
Yin L, Zhang D, Teng J, Xu D: Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma during pregnancy. Urol Int 2013;90:487-489.
4.
Pertia A, Gagua D, Managadze L, Chkhotua A: Treatment of renal cell carcinoma in pregnancy: simultaneous nephron-sparing surgery and Caesarian section (case report). Georgian Med News 2011;201:7-10.
5.
Royle G, Barry CL, Blacklock H, Lake Y: D-D dimers: a poor correlate of PPIH and subsequent outcomes. Int J Gynaecol Obstet 1998;62:37-42.
6.
Khochikar MV: Management of urological cancers during pregnancy. Nat Rev Urol 2010;7:195-205.
7.
Loughlin KR: The management of urological malignancies during pregnancy. Br J Urol 1995;76:639-644.
8.
Casella R, Ferrier C, Giudici G, Dickenmann M, Giannini O, Hosli I, Bachmann A, Sulser T: Surgical management of renal cell carcinoma during the second trimester of pregnancy. Urol Int 2006;76:180-181.
9.
Lawindy SM, Kurian T, Kim T, Mangar D, Armstrong PA, Alsina AE, Sheffield C, Sexton WJ, Spiess PE: Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int 2012;110:926-939.
10.
Shimada S, Saito H, Arai Y: Pulmonary embolism caused by spontaneous migration of tumor thrombus of renal cell carcinoma: a report of two cases. Int J Urol 2012;19:277-278.
© 2013 S. Karger AG, Basel
2013
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