Data Sheet 1_Case Report: En bloc resection of inferior vena cava and renal cell carcinoma with level IV tumor thrombus associated with tumor thrombus embolization to the pulmonary arteries: presence of blood vessels inside the tumor thrombus.docx

Renal cell carcinoma (RCC) is an aggressive kidney cancer often diagnosed at an advanced stage. This type of kidney tumor can be associated with tumor thrombus (TT), which can extend into the inferior vena cava (IVC) and, in severe cases, into the right side of the heart. Managing RCC with TT is particularly complex when extension of the TT into the right heart is present, as the use of intraoperative transesophageal echocardiography (TEE) and cardiopulmonary bypass (CPB) aid in performing a complete TT surgical resection. In terms of tumor neo-vessels, solid tumors such as RCC-TT depend on a vascularized connective tissue stroma for growth, proliferation and malformation which are supported by various factors promoting these processes. Herein, we present the case of a 69-year-old patient with a right renal tumor with a TT extending through the IVC up into the right side of the heart. During the surgery, a segment of the TT embolized into the pulmonary arteries, highlighting the surgical challenges, the use of CPB, and TEE in managing such cases, as well as discussing the implications of finding blood vessels inside the TT.

肾细胞癌（Renal cell carcinoma, RCC）是一种侵袭性肾癌，通常在确诊时已处于晚期。此类肾脏肿瘤可合并瘤栓（tumor thrombus, TT），瘤栓可延伸至下腔静脉（inferior vena cava, IVC），病情严重时可累及心脏右侧。当瘤栓侵犯心脏右侧时，合并瘤栓的肾细胞癌诊疗尤为复杂，此时术中经食管超声心动图（intraoperative transesophageal echocardiography, TEE）与体外循环（cardiopulmonary bypass, CPB）的应用，有助于实现完整的瘤栓手术切除。就肿瘤新生血管而言，以肾细胞癌-瘤栓为代表的实体瘤，其生长、增殖及畸形均依赖于血管化结缔组织基质，该病理过程由多种调控因子介导。本文报告1例69岁右肾肿瘤患者，其瘤栓经下腔静脉延伸至心脏右侧。手术过程中，一段瘤栓栓塞至肺动脉，这一情况凸显了此类病例的手术挑战、体外循环与术中经食管超声心动图的应用价值，并探讨了瘤栓内发现血管的临床意义。