Spontaneous Disappearance of Pulmonary Metastases in Hypernephroma; Final Report of Twenty-Year Follow-Up After Nephrectomy

Abstract

The higher incidence of renal cell carcinoma in males than in females is significant in the light of the possible hormonal and chemical dependency of the malignancy. The occasional incidence of spontaneous regression suggests that renal cell carcinoma may lack autonomy. Unusual latency in growth and delayed metastasis may indicate the presence of autoimmune mechanism within the host. Prolonged survival with primary or metastatic tumor further suggests some degree of host resistance. The peculiar biologic behavior of renal cell carcinoma is largely responsible for the difficulty in evaluating the response to various therapeutic modalities, especially chemotherapy. The purpose of this article is to present some of the noteworthy peculiarities of renal cell carcinoma. These data were obtained from a review of 270 cases of renal cell carcinoma treated at Roswell Park Memorial Institute, Buffalo, N. Y., from 1948-1968. These cases can be classified in the following categories: Hormonal influence, autoimmune mechanisms, pathogenesis, and therapeutic responses. Twelve case summaries are presented as examples of the possible influences of the above factors. One remarkable property of renal cell carcinoma is the occasional spontaneous regression of untreated primary disease and the disappearance of pulmonary metastasis following nephrectomy. The author speculates on the possible causes of this phenomenon.

Case Details

Personal Characteristics

The patient was 82 years of age at the time of death. He had lived exactly twenty years after the renal extirpation.

Clinical Characteristics

A preoperative chest x-ray had shown bilateral cannon-ball metastases. No lung biopsy was obtained; no radiotherapy was given either pre- or postoperatively. After leaving the hospital, the patient appeared to deteriorate and in summer 1945 frank hemoptysis occurred. Thereafter, his general condition improved with gain in weight and strength. Chest x-ray 22 months postoperatively disclosed complete disappearance of the pulmonary nodular shadows. The only abnormality noted was some linear fibrosis in the right lung. The patient was seen at regular intervals and remained asymptomatic except for a left inguinal hernia with several episodes of incarceration for which surgery was not performed. Repeated chest x-rays and bone surveys were consistently normal. In 1955 physical examination for an upper respiratory infection revealed no metastases and chest x-rays were again negative.

Remission Characteristics

The lung metastases disappeared spontaneously 22 months postoperatively and the patient remained free of symptoms to his death which occurred 20 years later at the age of eighty-two.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Nephrectomy

Additional Notes

The patient died following a cerebrovascular accident. No autopsy was obtained. Although there was no histological diagnosis of the lung lesion, there is no doubt that the lung deposits were metastatic, as interpreted by all established and accepted radiological criteria and as read by various reputable radiologists.