Tumor thrombus

Renal cell
carcinoma (TNM staging) • Renal cell carcinoma - Ganzer Fall bei Radiopaedia
Dawes L, Renal cell carcinoma. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-35937 • CC by-nc-sa 3.0 (modified)
Beware of
hepatocellular carcinoma in HIV-infected patients !. Arterial-phase acquisition (c,d) showed expansile, enhancing thrombosis (*) of portal bifurcation and left branch, ascites (+), faint patchy hyperenhancement along ventromedial and dorsal aspect of left liver lobe (arrowheads in d).
www.eurorad.org • CC by-nc-sa-4.0
Beware of
hepatocellular carcinoma in HIV-infected patients !. Arterial-phase acquisition (c,d) showed expansile, enhancing thrombosis (*) of portal bifurcation and left branch, ascites (+), faint patchy hyperenhancement along ventromedial and dorsal aspect of left liver lobe (arrowheads in d).
www.eurorad.org • CC by-nc-sa-4.0
Infiltrative-type
hepatocellular carcinoma with neoplastic portal thrombosis: value of diffusion-weighted and hepatocyte-specific contrast MRI. The massive portal thrombosis (arrowheads) appeared hypervascularised on arterial-dominant phase images (d,e) with a "thread-and-streaks" appearance.
www.eurorad.org • CC by-nc-sa-4.0
Infiltrative-type
hepatocellular carcinoma with neoplastic portal thrombosis: value of diffusion-weighted and hepatocyte-specific contrast MRI. High (800) b-value diffusion-weighted images (d..f in craniocaudal order) showed progression of the extensive signal changes from parenchymal infiltration (*) to the entire right liver and most of the enlarged caudate lobe.
www.eurorad.org • CC by-nc-sa-4.0
Renal cell
carcinoma (TNM staging) • Renal cell carcinoma with vena cava tumor thrombus - Ganzer Fall bei Radiopaedia
Di Muzio B, Renal cell carcinoma with vena cava tumor thrombus. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-52523 • CC by-nc-sa 3.0 (modified)
Budd-Chiari
syndrome • Hepatocellular carcinoma tumor thrombus resulting in Budd Chiari and right atrial invasion - Ganzer Fall bei Radiopaedia
Hartung, M. Hepatocellular carcinoma tumor thrombus resulting in Budd Chiari and right atrial invasion. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-74767 • CC by-nc-sa 3.0 (modified)
Inferior vena
caval thrombosis • Neoplastic thrombosis in the inferior vena cava - Ganzer Fall bei Radiopaedia
Fontanilla T, Neoplastic thrombosis in the inferior vena cava. Case study, Radiopaedia.org (Accessed on 04 Jan 2023) https://doi.org/10.53347/rID-30840 • CC by-nc-sa 3.0 (modified)
Beware of
hepatocellular carcinoma in HIV-infected patients !. T2-weighted images showed faint hyperintensities along ventromedial and dorsal aspects of left liver lobe (arrowheads) plus a centimetric nodule (thin arrow), moderately high signal of intrahepatic portal thrombus (*).
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Tumor thrombus is defined as tumor extending into a vessel, typically a vein. It occurs in a wide variety of malignancies. It is vital to distinguish tumor thrombus from "bland" thrombus (free of neoplastic cells) in the setting of neoplasia, as this often impacts staging and treatment approach.

Pathology

Tumor thrombus is usually composed of a soft tissue component and a thrombotic component.

Etiology

Tumor thrombus is perhaps most frequently associated with renal cell carcinoma, where tumor may invade the renal vein and grow caudally into the right atrium. However, this phenomenon is not isolated to renal cell carcinoma, and is recognized in :

Radiographic features

Ultrasound

Contrast-enhanced ultrasound is reported to be 100% sensitive and specific. The key feature of portal vein tumor thrombus is the presence of enhancement or color Doppler flow within the thrombus .

CT/MRI

Imaging features consistent with tumor thrombus on contrast-enhanced CT and MRI include:

  • presence of enhancement , the most specific sign
  • appearance of vessel expansion
  • diffusion restriction
Angiography

Streak and thread appearance of the tumor thrombus is characteristic in angiography due to parallel opacification of small vessels and arterial-venous shunting .

Nuclear medicine
FDG-PET

Increased activity associated with the presence of thrombus on CT

Treatment and Prognosis

In renal cell carcinoma, it may be possible to remove thrombus retrogradely at nephrectomy but the presence and nature of any tumor thrombus are important for determining the TNM stage.

In hepatocellular carcinoma (HCC), surgical resection is rarely performed in the setting of tumor thrombus given poor underlying liver function and high rate of recurrence even after liver transplant. For that, it is considered absolute contraindication to liver transplantation .

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Tumorthrombus:
Nierenzellkarzinom
 
Wikipedia • CC BY-SA 3.0
hepatozelluläres
Karzinom
Wikipedia • CC BY 3.0
lipomatöse
Impression der Vena cava inferior
Wikipedia • CC BY-SA 3.0
retroperitoneale
Tumoren
Wikipedia • CC BY 3.0
Thrombose der
Vena cava
Wikipedia • CC BY-SA 4.0
Tumorthrombus
bei Nierenzellkarzinom
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