Angiography In Spontaneously Healed Hypernephromas

Abstract

The natural history of renal cell carcinoma is kaleidoscopic. Growth may be indolent, intermittent, or rapid. The tumor may remain encapsulated for years. Ultimately it may invade intrarenal veins and lymphatics, thence to vena cava, aortic nodes, thoracic duct, and beyond. Spread to contiguous organs gives entry to portal and vertebral venous systems. Unusual metastases are common. Gross hematuria, loin pain, and mass occur together in only 10-15% and portend advanced neoplasm. Microscopic hematuria is found in about two-thirds. Non-specific signs and symptoms such as fatigue, weight loss, gastrointestinal symptoms, fever, and anemia are misleading. Fascinating clues such as hypercalcemia, erythrocytosis, hepatopathy, polyneuritis, acute left varicocele, etc., may alert the wary clinician. Rare but titillating spontaneous regression of hypernephroma metastases, usually pulmonary and in older males, have occurred whether or not nephrectomy is done. About 60 cases have been reported. Understanding this apparent tumor-specific immunologic response may bring earlier diagnosis and control of metastases. Selection of best treatment requires surveying metastatic sites. Accurate staging at operation and at the time of recurrence is imperative to help determine cause and correction of treatment failures.