1983 Volume 74 Issue 9 Pages 1692-1699
A rare case of renal cell carcinoma causing Budd-Chiari syndrome by thrombus of the inferior vena cava is reported.
A 50-year-old male was admitted to our hospital because of gross hematuria on May 7, 1977. Physical examination disclosed a fist sized tumor at the left upper quadrant. Excretory urography revealed a mass in the left kidney. Arteriographic studies demonstrated a hypervascular mass supplied from the two left renal arteries. Trans-abdominal nephrectomy was performed under the diagnosis of left renal cancer. The tumor had already extended into the inferior vena cava through the left renal vein. Tumor thrombus of the left renal vein could be resected, however, that of the inferior vena cava remained. Histological diagnosis was clear cell type renal adenocarcinoma. Postoperative irradiation was given on the area of the left renal fossa. After discharge from the hospital, lumbago, proteinuria, pain and edema in the lower extremities, hypertension and bloody phlegm were developed one after another for a period of 4 years. Finally, the patient was hospitalized due to increasing ascites on September 25, 1981, and died of liver and kidney insufficiency 5 weeks thereafter. Autopsy findings showed a tumor thrombus of the inferior vena cava from the bilateral common iliac veins to the right atrium with extension into the hepatic and right renal veins.
Including our case, 10 cases of secondary Budd-Chiari syndrome by renal malignancy have been reported in Japan. Of these 10 cases, 8 were renal call carcinoma and 2 were Wilms' tumor. Sex distinction was male 8 versus female 2. The affected side was right in 6 and left in 4. The majority of such cases died within one year after initial symptom occurred and expired within 3 months after ascites appeared. Hepatic coma was the most frequent cause of death. Autopsy findings in most cases showed tumor thrombus in the hepatic veins. As to the clinical course, Budd-Chiari syndrome induced from renal malignancy is usually preceded by symptoms of inferior vena cava obstruction by tumor thrombus such as proteinuria, leg edema and venous dilatation.
