Between 1950 and 1970, 44 patients (2.5 per cent) with renal cell carcinoma and a solitary metastatic lesion were treated at our clinic. Generally, treatment was aggressive, involving nephrectomy and excision of the metastatic lesion when possible. Patients presenting with the primary and metastatic lesion at the same time did not do as well as patients who presented with metastasis after nephrectomy. An operation for the metastatic lesion seemed to offer the best results in patients who presented with the solitary metastatic lesion after nephrectomy. The prognosis was uniformly poor in patients presenting with the primary and secondary lesion together, regardless of the mode of therapy. However, an operation seemed to be better marginally and did produce an occasional long-term survival.
As the first part of a three‐part study based on 80 cases of unusual renal tumors in adults, 26 cases of primary renal sarcoma are presented, including 15 leiomyosarcomas, five hemangiopericytomas, five liposarcomas and one pleomorphic rhabdomyosarcoma. Capsular localization was a feature of more than half the tumors (including all the liposarcomas), although some of the tumors were situated in relation to the renal pelvis or within the parenchyma. The clinical course of these tumors was that of aggressive malignancy, resulting in the death of 21 of the 26 patients. There were no associated features of the tuberous sclerosis complex among these cases.
The clinical and pathologic features of 43 cases of malignant renal tumor with mixed histopathologic features are presented. The characteristic features of embryonal nephroblastoma (Wilms' tumor) of infancy and childhood were seen in five adult cases. Renal‐cell carcinoma, intimately associated with a more pleomorphic spindle‐cell or giant‐cell malignancy resembling sarcoma, was the lesion in 37 cases. Areas of osteogenic sarcoma were noted in three tumors of this latter group and foci of transition of carcinoma cells to pleomorphic sarcomatoid cells could be demonstrated. A third distinctive mixed malignant tumor (one case in the series) was a transitional‐cell carcinoma of the kidney with a pleomorphic malignant‐appearing spindle‐cell stromal component. The term “sarcomatoid” is appropriate in the present incomplete state of knowledge of these unusual malignant neoplasms.
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