Simultaneous Pulmonary and Renal Malignancy* Daniel M. Libby, M.D ., F.C.C.P.;t Nasser K. Altorki, M.D., EC.C.P.;t Jeffrey Gold, M.D., F.C.C.P.;t W Reid Pitts, Jr., M.D.;t Neil H. Bander, M.D.;t and Sarah S. Frankel, M.D.§

Simultaneous primary malignancy of the lung and kidney has been rarely recognized during life. Three patients with synchronous primary pulmonary and renal cancer are described. The pulmonary tumors were asymptomatic and were discovered on plain chest roentgenography. The renal tumors, also asymptomatic, were incidentally discovered on Cf, performed for staging. Although one patient was treated with interleukin-2 for a presumed solitary pulmonary metastasis from renal carcinoma, in all three patients, both

simultaneous cancers involving visceral organs of different tissue types have been recognized fi>r over a century, but reports have comprised autopsy case series. Three criteria for classifying a patient as possessing multiple malignancies were set forth by Warren and Gates: 1 each tumor must present a definite pattern of malignant disease, each tumor must be distinct, and metastasis from one organ to the other must be excluded. An apparent increase in incidence of multiple malignancy may be related to successful treatment of the first cancer or to cytotoxic effects of radiotherapy and chemotherapy. The common use of ultrasonography, computerized tomography, multichannel blood screening, chest roentgenography, and the advancing median age of our society are factors which may lead to an increasing recognition of multiple primary malignancies. In order to plan diagnostic and therapeutic strategies, it is important to reCO).,'Ilize in which organs multiple malignancies are likely to arise, their common patterns of metastatic spread, and the clinical findings which are likely to be observed. Over the past year, we have encountered three patients with simultaneous primary cancers of the lung and kidney in whom both tumors were surgically removed either concurrently or sequentially.

the kidney and lung tumors were eventually removed either concurrently or sequentially. Prior autopsy case series are reviewed. In the elderly, synchronous asymptomatic pulmonary and renal malignancy is not surprising, and it should be approached as a distinct clinical problem. With the use of chest roentgenography for screening high risk populations and cr for staging, simultaneous primary pulmonary and renal malignancy will probably he recognized increasingly. (Chest 1990; 98:153-.56)

CASE HEI'OHTS CASE

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In 19H6. a 62-year-old male f(mner dgart'llt- smok•·r was f(nrnd to have an asymptomatie left uppt•r loht• mass on du·st roentgrnwd f(>r hyp•·nu·phroma (Fi~ I) without capsular or vaseular invasion and ne~atin· lymph nod. du·st rot•lltJ!t'lloJ!rapl"· n·n·aled t'lllarJ!t'lllt'llt of tht• lesio11. The patie11t was asymptomatie a11d had 11ormal n·sults o11 phy sieal exami11atio11. Chest Cr n•n•alt•d a11 irrt').(lllarly-shapeJ mass (.J X .j X 2 ..5 em) i11 the apieal St'J!mlt•s of the kidneys n·vealed a .J t'lll mass ill tht' ri).(ht kid11ey. showt·d illen·aSt·d uptake i11 tlw ri).(ltt liourth a11d 12th rihs. Tilt' CT of tht• chest a11d ahdollll'll sloowed a solitary left 11ppt•r lohe 111ass as well as a h l'lll lt'ft re11almass. Fiht>roptit· hro11dooseopy rt'\ealed a11 ullditlt>relllialt'd eart:i11oma. A pt•rt·utatwous trausthorat:ie llt't·dle biopsy was eo111irmatory. a11d tilt' t'\·tolo)!il' fi11di11J,!S wert' su).().(esli\'t' of primary h111J! eart:i11oma. Ht>11al arlt'rio)!rapl" showed a hyper, ·aseHiar tumor eo11fi11t•d to tht' eapsHit•. Opt'll sm)!ieal hiopsit•s of tlw rihs shmn·d old frad11res. l11 ja11uary 19H9, tilt' patio •11t u11derwe11t ldi radieal 11ephredomy. l'atholo)!\. shmn·d a11 ollet>Sh'rior rih pai11 in 1'\o\t' lllher 191>1>. A dlt'st roelltJ!

Simultaneous pulmonary and renal malignancy.

Simultaneous primary malignancy of the lung and kidney has been rarely recognized during life. Three patients with synchronous primary pulmonary and r...
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