18142              TUMOUR THROMBUS IN RIGHT HEART (PRIMARY GRAWITZ CARCINOMA)

This woman aged 68 had a renal cell carcinoma for which nephrectomy was performed.  The large mass of the tumour made resection difficult and a profuse haemorrhage occurred from the renal pedicle.  This was controlled by packing and transfusion but she collapsed and died on being moved from the table.  Postmortem was performed by the coroner’s pathologist.  At postmortem a mass of firm white formed material resembling tumour thrombus was found in the upper end of the inferior vena cava and continued through the right auricle and ventricle to the pulmonary conus where its apex was impacted, completely obstructing the pulmonary outflow tract.  A further mass of similar material was adherent in the inferior vena cava just below the diaphragm.  The right renal vein had been avulsed from the inferior vena cava, leaving a tear 1 cm in diameter.  There were metastases in the liver and in both lungs.

The specimen is the heart.  The right side has been opened to show the large mass of tumour thrombus in the right ventricle, with its apex impacted in the pulmonary artery.  The reverse of the specimen shows the ragged end of this mass in the cavity of the right atrium.  Histology shows a tumour thrombus infiltrated by bizarre giant carcinoma cells.