Spontaneous Disappearance of Pulmonary Metastases in Carcinoma of the Kidney

Abstract

Regression of pulmonary metastases following nephrectomy for renal cell carcinoma has occurred in two patients. In one patient, a hepatopathy also disappeared, and the patient remained free from disease for 16 years. In the other patient, following nephrectomy there was disappearance of hypercalcemia, presumably due to removal of a source of production of a parahormone-like polypeptide. It appears that older males with only pulmonary metastases make up the majority of patients in whom regression of metastases after nephrectomy has been observed. Hormonal and immunologic factors are implicated in this phenomenon. There is a sound rationale for nephrectomy in the presence of metastatic renal cell carcinoma.

Case Details

Personal Characteristics

The patient, a married woman, aged 49 years

Clinical Characteristics

Developed her first symptoms in july 1960. At that time she noticed haematuria (which lasted for three days), in which urine and blood were well mixed. A similar episode of haematuria, also lasting three days, occurred in december 1960. After this the patient developed intermittent backache, but despite these symptoms medical advice was not sought until april 1961, when she felt a mass in the right side of her abdomen. At about the same time, an attack of chest pain occurred, associated with a small hemoptysis.

Remission Characteristics

After operation in may 1961, the patient was referred to the peter maccallum clinic for consideration of treatment to the pulmonary metastases. Although a further radiograph of the chest taken at this time confirmed the presence of multiple metastases, the patient was symptom-free, and treatment was therefore deferred. There was no evidence of metastases elsewhere. Two months later, in july 1961, a radiograph of the chest was reported as being completely clear.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

A right nephrectomy was performed, and a massive renal tumour was removed

Additional Notes

The only alternative diagnoses, which were considered and then discounted on the clinical picture and the investigations, were atypical pulmonary sarcoidosis and multiple lung infarcts. The patient was subsequently reviewed with a chest radiograph every six months. She has remained well, and there have been no symptoms other than those relative to her hiatus hernia. The chest radiographs have remained clear for three years. The last review was in November 1964.