Regression of Metastases after Nephrectomy for Renal Cell Carcinoma

Abstract

The case of a 53-year-old man is reported. He complained of a severe cough which had lasted several weeks and was examined by Dr. M. L. Gelfand. A rounded mass in the upper left quadrant of the abdomen was found. Fluoroscopic and x-ray examination of the lungs showed bilateral densities. The patient underwent left nephrectomy for a large clear-cell carcinoma of the kidney. The lung metastases cleared over a period of two years after nephrectomy. His past medical history revealed that several months before examination he had undergone a prostatectomy. An intravenous pyelogram done at that time revealed no lung abnormaties. (Permission to reproduce case report denied by authors.)

Case Details

Personal Characteristics

53-year-old man, 1-year history of 30-pound weight loss, anorexia, and generalized weakness

Clinical Characteristics

Large right flank mass, no palpable lymph nodes, no other masses, hematocrit was 42%, white blood count 11,400, urinalysis showed no protein, sugar, wbcs or bacteria, but 7-8 rbcs per hpf, chest x-ray revealed 5 metastases, total serum protein was 6.3 gm% and albumin 2.1 gm%, alkaline phosphatase was 183 and 265 m units/ml, normal liver functions, no hypercalcaemia, large right renal mass, large renal cell carcinoma replacing most of the right kidney, extensively invading perirenal tissue, enlarged lymph nodes along the aorta and the common bile duct, poorly differentiated and spindle cell carcinoma interspersed with a few areas of the more classical clear-cell variety, metastatic renal cell carcinoma in lymph nodes

Remission Characteristics

One month after nephrectomy, only 2 of the metastases were still recognizable. Two months postoperatively only 1 metastasis was identifiable. This one was superimposed on the right hilum and did not change in size throughout this period, nor in the following 5 months. The liver functions had all returned to normal and the patient was feeling strong and robust.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Nephrectomy

Additional Notes

The patient developed new pulmonary and bone metastases after 1 year.