Spontaneous Regression Of Pulmonary Metastases From Hypernephroma
Annals of Surgery 156(5): Nov 1962; 852-856
View Original Source →Abstract
Spontaneous regression of pulmonary metastases in cases of hypernephroma is now well documented. Some 20 individual cases have been reported in the literature, to which we would add one further. In a review of the world literature and personal communications in 1964, Everson reported 18 cases of spontaneous regression of pulmonary metastases in hypernephroma. In both this and the present series there would seem to be 3 groups. The numbers are by no means large enough to stand up to statistical analysis, but are of some interest: Group 1, Regression of lung metastases with no treatment, 15%; Group 2, Appearance of pulmonary metastases following nephrectomy and their subsequent disappearance, 10%; Group 3, Regression following nephrectomy, 70%. To these may be added a further group, accounting for some 5%, in which the pulmonary lesions were apparently exacerbated by nephrectomy before eventual regression. The interval between nephrectomy and regression is extremely variable, ranging from one month to 4 years in the present series, the average period being some 11 months. It can only be said that our present knowledge is inadequate to account for the reported phenomenon but that it represents a rather rare but gratifying adjunct to nephrectomy. A case is reported in which the spontaneous regression of pulmonary metastases of hypernephroma occurred after nephrectomy.
Case Details
Personal Characteristics
57-year-old white man
Clinical Characteristics
Bilateral pulmonary lesions, symptoms of cough, sore throat, fever and general malaise, right chest pain located in the region of the seventh and eighth ribs, multiple pulmonary lesions compatible with the diagnosis of metastatic carcinoma in both lungs, a mass in the upper pole of the right kidney, necrotic tumor of the upper pole 6.0 centimeters in diameter with hemorrhagic foci and no vascular invasion, interstitial tissue was fibrotic and infiltrated with aggregates of lymphocytes
Remission Characteristics
Three months following operation there was almost complete disappearance of the previously described lesions in the lower lung fields. Six months after operation there was no evidence of any metastatic lesions on chest x-ray films. This remission has persisted to the present time. The most recent film, taken on july 31, 1961, was read as normal. The patient has had no evidence of other metastatic lesions in the 27 months following nephrectomy.
Treatment & Mechanisms
Proposed Remission Mechanisms
Not discussed
Clinical Treatment
Transperitoneal right nephrectomy, antibiotics, intravenous pyelography and gastrointestinal series
Additional Notes
The thirteenth case of spontaneous regression of pulmonary metastases from a hypernephroma after simple nephrectomy is reported. The propensity for this to occur in men is observed, as is the appearance of other metastases while the lung lesions disappear. Some concepts are considered in relation to theories of action.