PMC5484623_01
Computed tomography (CT) findings (A-C), resected specimen (D), and intraoperative laparoscopic findings (E) in Patient 1.. Notes: Hypervascular renal tumor (A) with IVC extension through cranial side renal vein (B) and caudal side of renal vein (C). Macroscopic appearance of the specimen is shown (D). Arrowhead indicates the tip of tumor thrombus in each renal veins. Laparoscopic appearance in retroperitoneal approach (E) shows IVC and renal artery (arrowhead, left) and dissected lumber vein (arrowhead, right).. Abbreviation: IVC, inferior vena cava.
rru-9-107Fig1.jpg
PMC5484623_01_rru-9-107Fig1.jpg
f1-rru-9-107
The tumor thrombus extended to IVC (level I) through two renal veins (Figure 1A-C). We could easily extend the retroperitoneal space, and the target artery was identified and dissected (Figure 1E).
PMC5484623_02
Computed tomography (CT) findings (A and B) and resected specimen (C) in Patient 2.. Notes: Right renal tumor directly invaded to ipsilateral adrenal gland (A and B). Arrowhead indicates cranial border with liver (left) and IVC (right). Surgical specimens are cut longitudinally (C). Yellow-colored tumor is observed at the upper pole of the kidney and adrenal invasion can be seen (arrowheads).
rru-9-107Fig2.jpg
PMC5484623_02_rru-9-107Fig2.jpg
f2-rru-9-107
A hypervascular tumor measuring 10 cm in diameter, located at the upper pole of the kidney, was invading directly into the IVC wall through the adrenal gland (Figure 2A-C).
PMC5484623_03
Computed tomography (CT) appearance in Patient 3.. Notes: Left renal tumor extended to IVC (A) and gonadal veins (B). Metastasis of lung (C) was reduced after presurgical treatment (D). Arrowheads indicate the tip of the tumor thrombus.
rru-9-107Fig3.jpg
PMC5484623_03_rru-9-107Fig3.jpg
f3-rru-9-107
IVC (Figure 3A) and left gonadal vein (Figure 3B). In addition, metastases were observed in lungs and hilar lymph nodes (Figure 3C and D). Initially, indication of the nephrectomy was questionable; however, we confirmed that metastases were controllable by presurgical axitinib treatment.