Spontaneous Regression of (Presumably) Pulmonary Metastases in A Patient with Renal ClearCell Carcinoma

Abstract

Presented is one case of spontaneous regression of pulmonary metastases of hypernephroma. The real frequency of spontaneous regressions of metastases of hypernephromas is difficult to access for a number of reasons. In some cases, histological proof of the metastatic nature of the lesions is absent; it is impossible to know the number of cases in which clinical and radiological pulmonary metastases exist, and neoplastic sites can remain quiescent for a large number of years. The most interesting aspect of spontaneous regression of pulmonary metastases of hypernephroma is, of course, elucidation of its mechanism. Several preliminary observations are made: (1) the relationship between nephrectomy and regression of metastases is not obvious since, in some cases, regression preceded nephrectomy; (2) a large majority of spontaneous regressions are pulmonary metastases of Grawitz tumors; and (3) the predominance of males in which the regression occurs is quite marked: 38 out of 51 are in the work of Freed, Halperin and Gordon(J Urol, 118: 1977; 538-542). Freed has also hypothesized that several mechanisms might account for spontaneous regression of metastases: (1) fever; (2) infection, especially tubercular infection; (3) trauma of operation; (4) diminution of blood flow to secondary sites; (5) suppression by nephrectomy of an unknown “cancerogenic” factor; (6) hormonal factors; and lastly; (7) immunological factors.

Case Details

Personal Characteristics

68-year-old man, moderate smoker, body weight was 73.5 kilograms and his height 1.69 meters, nervous man in good general condition, heart rate was 90 beats/minute, blood pressure 190/100 mmhg

Clinical Characteristics

Slight dyspnoea upon exertion and a dry cough for many years, slight hypertension, liver was slightly enlarged with a regular but blunt margin, no abnormalities in the thorax, kidneys could not be palpated, slight proteinuria, no glucosuria, no microscopic haematuria, esr, 10/24 mm/hour, hb 14.6 gm/ 100 ml, creatinine 9.8 mg/l, alkaline phosphatase 7.5 u/l, acid phosphatase 0.4u

Remission Characteristics

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.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Removal of the left kidney, thoracotomy, radiotherapy

Additional Notes

The patient had a history of cholecystitis and had his gallbladder removed in 1946. He also had vague upper abdominal discomfort and slight heartburn. His urine was clear and he had never observed haematuria. He did not report pain in the lumbar region. No abnormal lymph nodes were palpable. The head and neck were normal. The testes were normal at palpation. Rectal examination revealed no abnormalities. The reaction for occult blood in the stool was repeatedly negative. No sputum was produced.