Spontaneous Remission of Metastatic Renal Cell Adenocarcinoma: A Case Report

Abstract

A case of adenocarcinoma of the kidney, with regression of lung metastasis 8 years following nephrectomy, has been presented. Biopsy of the pulmonary metastatic nodules was not done. There seems to be no doubt of their origin, as there was gross and microscopic evidence of tumor tissue in the renal blood vessels, and metastatic nodules in the perirenal fat. This case is similar to the one reported by Mann, in that the metastasis was present at the time of nephrectomy. There is no answer as to why the metastasis regressed, only speculation.

Case Details

Personal Characteristics

75-year-old white man, well-nourished, moderately obese, well-oriented and well preserved, no family history of malignant disease, previous medical history of tonsillitis

Clinical Characteristics

Nonradiating pain in left flank, hematuria and sputtering urination with the passage of clots, urinary urgency, no weight loss, cardiorespiratory or gastrointestinal disorders, small (0.5 centimeter diameter) basosquamous cell carcinoma of the skin of the scalp, emphysematous chest, harsh mitral and aortic systolic murmurs, firm, slightly movable and tender left renal mass about 8 centimeters in diameter, large reducible right inguinal hernia, varicocele in left side of scrotum, slightly enlarged, firm and symmetrical prostate, low hemoglobin, normal blood sugar, blood urea nitrogen and creatinine, metastatic lesions in both lung fields, nonfunctioning left kidney, mass lesion in the lower pole of the left kidney

Remission Characteristics

Pulmonary metastatic lesions spontaneously regressed after nephrectomy and remained absent two years nine months after surgery

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Nephrectomy

Additional Notes

The patient made an uneventful recovery and returned to his usual business. When last seen (2 years postoperatively) he stated that he had not lost a day from work. X-rays taken 18 and 24 months after operation showed no metastatic disease in chest. An intravenous urogram and another chest film two years later showed a normal functioning right kidney and clear lung fields. A complete history and physical examination 3 years later showed no new findings. His weight was the same. A repeat of laboratory studies revealed results within normal limits along with a normal sedimentation rate. No medication was given other than 500 cc whole blood preoperatively, a short course of feosol spansule, one b.i.d. for six weeks postoperatively and penicillin parenterally for an episode of tracheobronchitis six months after surgery. The patient died October 3, 1958. A complete postmortem examination was made. No metastatic lesions were seen in the skull or viscera. According to Dr. R. Philip Custer, pathologist at Presbyterian Hospital, death was caused by congestive heart failure due to arteriosclerosis and hypertensive cardiovascular disease.