Inferior vena cava thrombus shrinkage in patient with adult Wilms' tumor: A Case report

Introduction and importance: Adult Wilms' tumor is infrequent in adults and usually has poor prognosis. We report a case of inferior vena cava thrombus shrinkage in patient with adult Wilms' tumor. Case presentation: A 27-year-old male came to hospital due to pain in his left flank and repeated hematuria since one year ago. An inhomogeneous mass and thrombus in IVC and abdominal aorta near renal artery were found from his abdominal CT scan with contrast, so cytoreductive nephrectomy was performed. However, the patient was unstable during operation so the thrombus couldn't be operated. Post-op immuno-histo-chemistry evaluation conethicfirmed the diagnosis of adult Wilms Tumor. A follow-up CT scan with contrast showed shrinkage of thrombus size with no sign of peripheral congestion. This phenomenon was rare in adult Wilms tumors, especially when the patient didn't undergo thrombus removal or adjuvant chemotherapy. Clinical discussion: Adult Wilms' tumor tends to invade blood vessels in the form of thrombus, as shown in this case. Up to 4% of patients with thrombus had it around vena cava [3,4]. The recommended treatment is open surgery. Patients with chronic thrombus obstruction might have several venous collateral pathways to maintain blood flow to the right atrium. Generally, there are three major alternative pathways found in such complications. Conclusion: This study presented a patient with adult Wilms' tumor that experienced post-operative thrombus shrinkage without doing adjuvant chemotherapy or thrombus removal during surgery.