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URORADIOLOGY
Year : 2015  |  Volume : 31  |  Issue : 1  |  Page : 79-80
 

Gonadal vein tumor thrombosis due to renal cell carcinoma


Department of Radiology, Shohada e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Web Publication1-Jan-2015

Correspondence Address:
Dr. Mohammad Ali Karimi
Department of Radiology, Shohada e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.139553

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   Abstract 

Renal cell carcinoma (RCC) had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC


Keywords: Computed tomography, gonadal vein, renal cell carcinoma, thrombosis


How to cite this article:
Haghighatkhah H, Karimi MA, Taheri MS. Gonadal vein tumor thrombosis due to renal cell carcinoma. Indian J Urol 2015;31:79-80

How to cite this URL:
Haghighatkhah H, Karimi MA, Taheri MS. Gonadal vein tumor thrombosis due to renal cell carcinoma. Indian J Urol [serial online] 2015 [cited 2019 Sep 21];31:79-80. Available from: http://www.indianjurol.com/text.asp?2015/31/1/79/139553



   Introduction Top


Renal cell carcinoma (RCC) had a tendency to extend into the renal vein and inferior vena cava (IVC), [1] while gonadal vein tumor thrombosis (GVT) has been rarely reported. [2],[3],[4],[5] GVT is a rare entity, typically seen as a complication of postpartum endometritis, pelvic inflammatory disease, and gynecologic surgery. Even among patients with malignancy, GVT is typically a bland thrombus rather than a tumor thrombus. [6]


   Case Top


A 57-year-old female presented with back pain and paraparesia, leading to the incidental discovery of a heterogeneous large mass involving the left kidney with vertebral, liver and pulmonary metastases, and invasion to the IVC and renal vein as well as ovarian vein tumor thrombosis, which was documented in contrast-enhanced CT by an enhancing low attenuation filling defect within dilated left ovarian vein [Figure 1] and [Figure 2]. CT guided biopsy from a vertebral lesion confirmed metastasis from renal cell carcinoma. After angiographic embolization for this unresectable tumor, external radiotherapy was administered for palliation. Several months later, she died due to extensive metastatic disease to brain, lung, liver, and bones.
Figure 1: An enhancing left renal mass containing necrosis and calcification is seen invading left renal vein (white arrows in a and b) and inferior vena cava (black arrows) with metastatic lesions of T12 vertebra. Tumor thrombosis of left ovarian vein (arrows in c and d) is evident as enhancing filling defect within dilated vein

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Figure 2: Coronal reformatted computed tomography images show a heterogeneous mass in the left side of the aorta and thrombosis of the inferior vena cava (curved arrow) and left ovarian vein (white arrow) with enhancement pattern similar to the mass

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   Discussion Top


Ovarian veins originate from the plexus in the broad ligament near the ovary and  Fallopian tube More Details and communicate with the uterine plexus, then course anterior to the psoas muscle and the ureter. The left gonadal vein drains into left renal vein and therefore the left renal tumor can extend retrograde into the left gonadal vein. Diagnosis of GVT is a challenging issue and is usually underdiagnosed, especially in the nonpostpartum patients who do not show typical manifestation, including lower abdominal or flank pain, fever, and a deep tender mass. Contrast-enhanced multidetector CT is the most reliable diagnostic modality. GVT typically presents as a filling defect in a tubular structure (dilated ovarian or testicular vein) anterior to the psoas muscle with a central round low-attenuation center and peripheral higher attenuation rim. Enhancement of this filing defect indicates that it is a tumor thrombus rather than a simple bland thrombus. The enhancement pattern will be identical to that of the original tumor. Dilatation and tortuosity of pelvic veins is a common associated finding.

Unlike postpartum or post pelvic surgery GVT, GVT associated with malignancy may be asymptomatic. [6] The possibility of GVT should be kept in mind when looking at an imaging study of patients with RCC, in whom tumor thrombosis of ovarian vein is a sign of more advanced disease and may be associated with a poor prognosis.

 
   References Top

1.
Curti BD. Renal cell carcinoma. JAMA 2004;22:97-100.  Back to cited text no. 1
    
2.
Goyal A, Rangarajan K, Singh P, Das CJ. Role of imaging in successful management of malignant ovarian vein thrombosis in RCC. BMJ Case Rep 2014 ;7:2014.  Back to cited text no. 2
    
3.
Thomas AA, Herts BR, Campbell SC. Gonadal vein tumor thrombus in metastatic renal cell carcinoma. Urology 2009;73:1229-30.  Back to cited text no. 3
    
4.
Ghersin E, Leiderman M, Meretik S, Kaftori JK, Amendola MA, Engel A. Renal cell carcinoma invading the right ovarian vein: Multidetector computed tomography and ultrasound Doppler findings. J Comput Assist Tomogr 2005;29:472-4.  Back to cited text no. 4
    
5.
Kota S, Tsuneo M, Kazuo W, Yoshio H, Hideki Y. Renal cell carcinoma with tumor thrombus in the gonadal vein: A case report. Japan J Clin Urol 2001;55:269-71.  Back to cited text no. 5
    
6.
Jacoby WT, Cohan RH, Baker ME, Leder RA, Nadel SN, Dunnick NR. Ovarian vein thrombosis in oncology patients: CT detection and clinical significance. AJR Am J Roentgenol 1990;155:291-4.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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    References
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