Leiomyosarcoma of retro-hepatic portion of inferior vena cava (IVC) is a rare vascular tumor with poor prognosis if adequate surgical resection is not achieved. Surgical repair includes dissection of the tumor and reconstruction of the IVC with a tube graft. Establishing a normal flow and gradient in IVC and hepatic veins is imperative for a successful repair. We report a case of retro hepatic IVC leiomyosarcoma where the preoperative computed tomography described the anatomy and extension of the tumor whereas intraoperative transesophageal echocardiography helped in the assessment of adequacy of surgical repair.

Renal cell cancer (RCC) is at times associated with intravascular tumour thrombus (TT), which in rare cases can extend to the right atrium. The management of RCC with intravascular tumour thrombus is complex and requires a multidisciplinary approach involving urologists, vascular surgeons, and cardiologists. The pre-operative workup is extensive and includes imaging studies to determine the extent of the tumour thrombus and assess the patient\'s overall health status. Here, we present a case report detailing the operative and perioperative management of a patient presenting with renal cell cancer and intravascular TT.

Xanthogranulomatous pyelonephritis (XPG) is a known clinical entity; however, the further progression of this inflammatory pathology to adjacent organs, including the ureter, bladder and urethra, is extremely rare. Xanthogranulomatous inflammation of the ureter is a chronic inflammatory state where foamy macrophages are seen in the lamina propria along with multinucleated giant cells and lymphocytes forming a granulomatous inflammation, which is benign. Based on its appearance on computed tomography (CT) scan images, it can easily be misidentified as a malignant mass, and the patient can be subjected to surgery that can lead to complications. Here we present a case of an elderly male with a known case of chronic kidney disease with uncontrolled type 2 diabetes mellitus who presented with fever and dysuria. Upon further radiological investigations, the patient had underlying sepsis and was seen to have a mass involving the right ureter and inferior vena cava. Upon biopsy and histopathology, he was diagnosed with xanthogranulomatous ureteritis (XGU). The patient underwent further treatment and was followed up.

Leiomyosarcoma is an aggressive soft tissue tumor originating from smooth muscle cells typically of the uterus, gastrointestinal, or genitourinary system. The most common site of leiomyosarcoma of soft tissue is the retroperitoneum, accounting for 50% of all cases. The majority of patients are asymptomatic, which may be due to the large retroperitoneal cavity. However, when symptoms do occur, they are vague in nature. The most common growth pattern is an entirely extravascular mass. We are presenting an interesting case of a 65-year-old lady, who was referred to our hospital as a case of large left retroperitoneal mass with left renal vein thrombosis. She was biopsied and diagnosed with leiomyosarcoma with invasion into descending colon and the left renal vein, which led to renal vein thrombus. In the last few decades, there is a lack of studies about leiomyosarcoma invading the renal vein and Inferior Vena Cava (IVC). As far as we know, the leiomyosarcoma of a major blood vessel is extremely rare. Since leiomyosarcoma often has a late presentation with the advanced stage when detected, a high index of suspicion is needed to be detected early and avoid such a complication.

Renal cell carcinoma (RCC) is a slow-progressing cancer that may cause tumor embolism in the inferior vena cava (IVC) and has a high mortality rate. Treatment for IVC metastasis of RCC is basically surgical resection often requiring cardiopulmonary bypass. RCC has been regarded as a radio-resistant tumor; however, stereotactic radiotherapy (SRT) has proven effective in recent years. We present a case of advanced RCC in which CyberKnife radiotherapy was successful in saving and preserving quality of life. An 81-year-old male presented with severe edema in both legs. Contrast CT scan displayed giant tumor in IVC and bilateral mediastinal lymphadenopathy. The cancer appeared to originate from the lower pole of the right kidney. The tumor protruded into the right atrium, and surgical resection with pump oxygenator was impossible due to patient\'s age. CyberKnife SRT was performed for tumor in the IVC. Biopsy for hilar lymph node revealed clear cell RCC, and the second CyberKnife treatment was performed. The patient is surviving over three years without any symptoms. CyberKnife was successful in preserving patient\'s quality of life for advanced stage IV RCC.

Primary leiomyosarcoma is rare malignant tumour arising from the smooth muscles and can appear at any site where smooth muscle is present. It is more common in the peripheral vessels and has predilection for the female sex. We here report a rare case of leiomyosarcoma involving the segment I & II of inferior vena cava with extension into the renal veins in a 70 year old male patient. Midline transperitoneal approach was taken to excise the tumour along with the vessel wall with anastomosis between the right renal vein and the infrarenal inferior vena cava with a reversed great saphenous vein graft thereby salvaging the right kidney.

Inferior vena cava (IVC) leiomyosarcoma is a rare malignant neoplasm more commonly seen in women in the fifth to sixth decade of life. Complete resection of the tumor with negative margins is the only therapeutical option that has demonstrated a survival benefit. This report presents a case of a 67-year-old woman affected by a lower segment IVC leiomyosarcoma incidentally detected during a chronic abdominal pain study. The patient was treated with tumorectomy, resection and ligation of the infrarenal IVC without signs or recurrence on a 12-month follow-up.

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