Vol. 116, December Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1976 by The Williams & Wilkins Co.
SPONTANEOUS REMISSION OF SOLITARY BONY METASTASIS AFTER REMOVAL OF THE PRIMARY KIDNEY ADENOCARCINOMA K. H. DOOLITTLE ABSTRACT
The second case of spontaneous remission of a biopsy-proved osseous metastasis from a renal carcinoma is reported. The unusual feature of the patient presenting with a right varicocele and no hematuria is extremely rare. B. a in 1967 with a ureteral caiculus gust 1970 for a l ½-year of an varicocele and a left arm. He was admitted to the hospital for diand treatment. examination revealed the right varicocele. Urine showed no red with a normal hemogram and blood urea nitrogen. An initial excretory urogram (IVP) was read as normal after careful with the retrograde pyelogram. The patient was taken to the operating room for ligation of the right varicocele.
DISCUSSION
definition spontaneous regression of metastatic tumors treatment to the metastatic site. 40 are available for 37 were metastases, 1 each was intestinal, osseous and cutaneous. Of the 37 pulmonary lesions 28 regressed after 2 after irradiation of the site and 1 spontaneously without nephrectomy. The remaining 6 cases were found after nephrectomy and subsequently regressed.
A, metastatic tumor in left humerus. B, tumor in lower pole ofright kidney. C, comparison of normal right arm and left arm now free of tumor
During further evaluation for the cause of the right varicoOnly 10 of the 40 cases had metastatic lesions proved by cele an osteolytic lesion of the left humerus was found (part A biopsy. Therefore, this is the second case reported of spontaneof figure). Biopsy revealed a vascular metastatic adenocar- ous remission of an osseous metastasis from a renal carcinoma cinoma of the kidney. A high volume IVP with nephrotomo- with a 4-year followup. The other interesting feature of this grams now demonstrated a tumor on the medial lower pole of case is the presenting complaint of a right varicocele. The the right kidney (part B of figure). Chest x-ray, bone survey finding of a right varicocele mandates careful extensive evaluaand iiver scans were negative for further metastatic disease. tion of the patient. The patient was returned to the operating room for an 5320 East Main St., Columbus, Ohio 43213 abdominal radical right nephrectomy. Convalescence was uneventful except for a wound infection. Followup studies 6 REFERENCES weeks postoperatively revealed that the bony lesion had GARFIELD, D. H. AND KENNEDY, B. J.: Regression of metastatic renal decreased in size. It had completely disappeared on studies 6 cell carcinoma following nephrectomy. Cancer, 30: 190, 1972. months later and has not recurred to date (part C of figure). GoNICK, P. AND JACKIW, N. M.: Regression of pulmonary metastases The lungs have remained free of metastatic disease. from renal adenocarcinoma. J. Urol., 92: 270, 1964. J. M.: Natural history and staging of renal cell carcinoma. CA, 25: 121, 1975. MARKEW!TZ, M., TAYLOR, D. A. AND VEENEMA, R. J.: Spontaneous regression of metastases following palliative nephrectomy. Case report 20: 1147, 1967. HOLLAND,
for publication June 1976. at annual meeting of Centr2.l Urologicc.1 Association, Phoen]_x Ari.zona: O~tober 5-12 1
803
804
DOOLITTLE
B., SCHLUMBERGER, F. C. AND GOODWIN, W. E.: A 10-year evaluation of nephrectomy for extensive renal-cell carcinoma. J. Urol., 95: 10, 1966.
MIMS, M. M., CHRISTENSON,
COMMENT
The case reported illustrates the unpredictable behavior of renal cancer. It has been our experience and the experience of others that osseous metastases seldom regress after removal of the primary tumor.
In fact, we have seen 1 case in which lung metastases disappeared with nephrectomy, while bone metastases continued to grow rapidly. The case also illustrates why one should wait a reasonable period after nephrectomy before proceeding with an amputation for metastatic renal cancer. The danger in deferring treatment of an osseous metastasis is pathologic fracture. One would have to wonder whether the patient's wound infection played any role in inducing the regression of the osseous metastasis. Improved survival of patients with lung cancer has been reported to be associated with postoperative empyema. E.E.F.
THE JOURNAL OF UROLOGY
Copyright© 1976 by The Williams & Wilkins Co.
SPONTANEOUS REMISSION OF SOLITARY BONY METASTASIS AFTER REMOVAL OF THE PRIMARY KIDNEY ADENOCARCINOMA K. H. DOOLITTLE ABSTRACT
The second case of spontaneous remission of a biopsy-proved osseous metastasis from a renal carcinoma is reported. The unusual feature of the patient presenting with a right varicocele and no hematuria is extremely rare. B. a in 1967 with a ureteral caiculus gust 1970 for a l ½-year of an varicocele and a left arm. He was admitted to the hospital for diand treatment. examination revealed the right varicocele. Urine showed no red with a normal hemogram and blood urea nitrogen. An initial excretory urogram (IVP) was read as normal after careful with the retrograde pyelogram. The patient was taken to the operating room for ligation of the right varicocele.
DISCUSSION
definition spontaneous regression of metastatic tumors treatment to the metastatic site. 40 are available for 37 were metastases, 1 each was intestinal, osseous and cutaneous. Of the 37 pulmonary lesions 28 regressed after 2 after irradiation of the site and 1 spontaneously without nephrectomy. The remaining 6 cases were found after nephrectomy and subsequently regressed.
A, metastatic tumor in left humerus. B, tumor in lower pole ofright kidney. C, comparison of normal right arm and left arm now free of tumor
During further evaluation for the cause of the right varicoOnly 10 of the 40 cases had metastatic lesions proved by cele an osteolytic lesion of the left humerus was found (part A biopsy. Therefore, this is the second case reported of spontaneof figure). Biopsy revealed a vascular metastatic adenocar- ous remission of an osseous metastasis from a renal carcinoma cinoma of the kidney. A high volume IVP with nephrotomo- with a 4-year followup. The other interesting feature of this grams now demonstrated a tumor on the medial lower pole of case is the presenting complaint of a right varicocele. The the right kidney (part B of figure). Chest x-ray, bone survey finding of a right varicocele mandates careful extensive evaluaand iiver scans were negative for further metastatic disease. tion of the patient. The patient was returned to the operating room for an 5320 East Main St., Columbus, Ohio 43213 abdominal radical right nephrectomy. Convalescence was uneventful except for a wound infection. Followup studies 6 REFERENCES weeks postoperatively revealed that the bony lesion had GARFIELD, D. H. AND KENNEDY, B. J.: Regression of metastatic renal decreased in size. It had completely disappeared on studies 6 cell carcinoma following nephrectomy. Cancer, 30: 190, 1972. months later and has not recurred to date (part C of figure). GoNICK, P. AND JACKIW, N. M.: Regression of pulmonary metastases The lungs have remained free of metastatic disease. from renal adenocarcinoma. J. Urol., 92: 270, 1964. J. M.: Natural history and staging of renal cell carcinoma. CA, 25: 121, 1975. MARKEW!TZ, M., TAYLOR, D. A. AND VEENEMA, R. J.: Spontaneous regression of metastases following palliative nephrectomy. Case report 20: 1147, 1967. HOLLAND,
for publication June 1976. at annual meeting of Centr2.l Urologicc.1 Association, Phoen]_x Ari.zona: O~tober 5-12 1
803
804
DOOLITTLE
B., SCHLUMBERGER, F. C. AND GOODWIN, W. E.: A 10-year evaluation of nephrectomy for extensive renal-cell carcinoma. J. Urol., 95: 10, 1966.
MIMS, M. M., CHRISTENSON,
COMMENT
The case reported illustrates the unpredictable behavior of renal cancer. It has been our experience and the experience of others that osseous metastases seldom regress after removal of the primary tumor.
In fact, we have seen 1 case in which lung metastases disappeared with nephrectomy, while bone metastases continued to grow rapidly. The case also illustrates why one should wait a reasonable period after nephrectomy before proceeding with an amputation for metastatic renal cancer. The danger in deferring treatment of an osseous metastasis is pathologic fracture. One would have to wonder whether the patient's wound infection played any role in inducing the regression of the osseous metastasis. Improved survival of patients with lung cancer has been reported to be associated with postoperative empyema. E.E.F.
