Giant renal cell carcinoma with renal vein thrombus: a case report and surgical management

Introduction and importance: Renal cell carcinoma (RCC) is the most common malignant renal neoplasm and may remain asymptomatic until advanced stages. Giant RCCs are rare and often present with extensive local invasion or venous involvement, posing significant diagnostic and therapeutic challenges. Case presentation: We report the case of a 65-year-old male with poorly controlled diabetes mellitus, hypertension, and a history of coronary artery disease who initially presented with abdominal pain. Physical examination revealed a large, non-tender right upper quadrant mass. Ultrasonography and contrast-enhanced computed tomography demonstrated a heterogeneous renal lesion with cystic and solid components, intralesional calcifications, and venous extension with inferior vena cava compression. Enlarged para-aortic lymph nodes were also identified. Laboratory findings showed impaired renal function and anemia. The patient underwent radical nephrectomy with complete excision of the tumor and thrombectomy of the renal vein. The adrenal gland was preserved. Perioperative management included glycemic control, and the postoperative course was uneventful, with improvement in renal function. Clinical discussion: RCC often grows silently, may present as giant renal masses with venous involvement, and requires radical nephrectomy with thrombectomy for optimal management and prognosis. Conclusion: This case illustrates the indolent nature of RCC, which may attain massive size before detection, and highlights the central role of imaging in diagnosis and surgical planning. Radical nephrectomy with thrombectomy remains the cornerstone of management in patients with locally advanced disease, offering the best chance for favorable outcomes when complete resection is achieved. Long-term follow-up is essential due to the risk of recurrence.