Liver Infiltration From a Huge Renal Cell Carcinoma: A Diagnostic and Management Enigma

Renal Cell Carcinoma (RCC) is the most lethal malignancy of urinary tract. Invasion of right lobe of liver by RCC is rare and possess a treatment challenge. Simultaneous nephrectomy with right hepatectomy has been proposed as a part of multi-modality treatment approach. We herein discuss a patient who underwent simultaneous nephrectomy with right hepatectomy along with single peritoneal metastasectomy for a huge RCC of right kidney and infiltrating the right lobe of liver. A 30- year old female was diagnosed with a right renal tumor invading into the right hepatic lobe. Post multi-disciplinary tumor board meeting she was planned for surgical intervention. Intra-operatively a single peritoneal nodule was present which came positive for malignancy on frozen section. Considering young age, good performance status and oligometastatic disease definitive procedure in the form of combined right nephrectomy and right hepatectomy was performed. She was discharged from the hospital on 6th post-operative day with an uneventful post-operative course. This type of RCC has been rarely reported and the combined nephrectomy and right hepatectomy is safe and feasible for this type of huge RCC invading right hepatic lobe.