Spontaneous Regression of Pulmonary Metastases Secondary to Carcinoma of Kidney

Abstract

Regression of pulmonary metastatic nodules from a carcinoma of the kidney occurs infrequently. Most observations deal with disappearance of pulmonary metastases after removal of the renal carcinoma, but regression of pulmonary metastatic disease has also been described without prior removal of the primary renal carcinoma. Finally, metastatic pulmonary lesions have been observed to appear after nephrectomy and to disappear spontaneously later. In this context the unusual behaviour of presumptive pulmonary metastases in a patient with a renal clear cell carcinoma seemed to be of sufficient interest to report. Without the removal of the primary tumour the metastases disappeared radiologically. About nine months later, before radical nephrectomy, new pleural pulmonary lesions were found. These lesions were histologically proven metastases from the primary renal clear-cell carcinoma.

Case Details

Personal Characteristics

A sports groundsman, w. N., aged 61, obese, very ill man, weight had dropped from 18 stone (110 kilograms) to 16 stone (102 kilograms)

Clinical Characteristics

Multiple non-specific symptoms, no respiratory distress, slightly cyanosed, chest radiograph showed numerous opacities in both lung fields, normal barium meal and follow-through and a barium enema, no red cells in the urine, developed pains in the left shoulder and arm, developed haematuria and pain in the left loin

Remission Characteristics

Six weeks later he was seen at follow-up. Surprisingly he looked improved. A chest radiograph showed a remarkable clearing of the lesions in both lung fields, except for one small round focus in the right upper zone. He was seen again four weeks later, on december 29, 1958. He was so well that he was asking to return to work. A chest radiograph showed further clearing of the lesions in both lung fields.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

No specific treatment was given

Additional Notes

At autopsy his respiratory system showed moderate bilateral bronchitis. In each lung there were three or four small, neoplastic deposits, each not exceeding 0.5 centimeters diameter, and some involving the visceral pleura. There was minimal bronchopneumonia at both lung bases. Kidneys: There was malignant tumour, with the macroscopic appearance of hypernephroma, 4 centimeters diameter. The cause of death was ascribed to carcinoma of the left kidney, with metastases in the floor of the third ventricle, thyroid and lungs. Histologically, the tumours were pleomorphic, but essentially spindle cell primary carcinoma of kidney.