Spontaneous Disappearance of Lung Metastases in a Case of Kidney Carcinoma (Hypernephroma)

Abstract

A case of adenocarcinoma of the kidney with regression of pulmonary metastases following nephrectomy is presented. The pertinent literature is reviewed.

Case Details

Personal Characteristics

A bus driver (j. C.), aged 55 years

Clinical Characteristics

Swelling in the left sac of the scrotum for a year, undue fatigue for three months, and a cough for years, recently productive of yellow sputum. A left varicocele, a grossly enlarged palpable left kidney, a blood-pressure of 200/120, and hb 18.3 grams (124%). The esr was 1 mm/hour (wintrobe), and microscopy of the urine revealed no abnormality. Radiography of the renal area revealed calcification in the lower pole of the enlarged left kidney. Radiographs of the thorax at this time showed an opacity in the right lower zone suggestive of a secondary deposit.

Remission Characteristics

Three months later a postero-anterior film of the chest failed to reveal a definite lung shadow, and in many subsequent postero-anterior and lateral films no trace of the shadow was present. Eighteen months after the last film showing the shadow, tomographic cuts showing the whole thickness of the chest showed no trace of any deposits in the lung fields.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Left nephrectomy, exploratory right thoracotomy, radiotherapy

Additional Notes

The patient remained in reasonable health and without clinical or radiological evidence of metastasis for eighteen months after nephrectomy, when he complained of pain in the right buttock, soon extending down the leg. The patient was given a maximal skin dose of 2000 roentgens (factors: 250kV, 50 centimeters F.S.D., 1.9mm Cu H.V.L.). This treatment gave little relief of pain and he was kept in hospital, the growth in the sacrum being observed to extend gradually, involving eventually lumbar vertebrae and forming a pelvic mass. There was also evidence of nerve-root involvement. He required increasing sedation and steadily deteriorated to death two and a half years after the nephrectomy. At no time had he been treated with hormones or any other drug likely to affect the course of the malignant mass. During the last six months of his life his Hb level went from 14.9 (114%) to 14.5 (98%). Autopsy showed extensive infiltration of the retroperitoneal tissues extending to and involving the seminal vesicles. The growth had a vascular polypoid appearance. The right kidney showed compensatory hypertrophy. The lumbar vertebrae and sacrum were extensively invaded by growth involving the cauda equina. Microscopy showed this to be the same clear-celled type of carcinoma. The lungs showed no evidence of secondary deposits or other abnormality except mild emphysema on extensive sectioning. The brain was not examined, but other organs showed no significant abnormality.