Metastatic patterns of renal carcinoma: An analysis of 687 necropsies

Abstract

The metastatic behaviour of renal cell carcinoma has been studied in a series of 687 necropsies. The observations were consistent with the concept of "metastatic inefficiency", in that in 295 cases, including 25 with renal vein invasion, there were no detectable metastases. In the present series, renal vein involvement was not an important prognostic factor in stage 1 or 2 disease. In 73% of cases without lung metastases there were none in other sites, and in 84% of those with lung metastases there were others elsewhere, consistent with a metastatic "cascade" in which metastases first developed in the lungs and were later detected in other organs. However, the observations did not permit discrimination between anatomic cascades, in which other organs were seeded from metastasizing pulmonary metastases, and temporal cascades, in which the other were seeded at the same time as the lungs, but with fewer cancer cells. The patterns of arterial metastasis were consistent with the "seed-and-soil" hypothesis, and a novel index was developed to quantify differential organ "soils". The contralateral kidney was not the best soil for metastases from renal carcinoma. Given the presence of lymph node metastasis, the probability of heamatogenous metastasis is 90%. However, in the absence of nodal metastasis, approximately half the cases had haematogenous metastasis.

Cancer metastasis networks and the prediction of progression patterns

“…These have all been relatively small-scale studies (Abrams et al, 1950;Weiss et al, 1988;Weiss, 1992;Disibio and French, 2008). However, we may now study these patterns using computational methods on large data sets.…”

Metastasis to gallbladder and adrenal gland of renal cell carcinoma

“…However, gallbladder metastasis of RCC is seldom detected, being present in 0.58% of autopsies (2). In a review of the literature, we found 15 reported cases of gallbladder metastasis of RCC (6)(7)(8).…”

“…However, gallbladder involvement in patients with RCC is extremely rare. The gallbladder was identified as a metastatic site in only 4 out of 687 cases (0.58%) in large autopsy reviews (2). Patients with distant metastasis from RCC have a poor prognosis, with a 5-year survival rate of <10% (3).…”

Metastasis to the gallbladder: A single-center experience of 20 cases in South Korea

“…In an autopsy series of 125 patients with malignant melanoma, nineteen (15%) had MGBs [2] . In an analysis of 687 necropsies of patients with renal cell carcinoma, four cases had MGBs [3] . However, the data available on MGBs are only from autopsy series of certain malignancies such as melanoma or renal cell carcinoma, or reviews of a certain metastatic carcinoma to the GB such as melanoma [6,7] , or in the form of single case reports of tumors such as melanoma [8][9][10][11] , breast cancer [4] , and hepatocellular carcinoma [5] .…”

“…Although malignant melanoma [2] and renal cell carcinoma [3] are reported to metastasize to the gallbladder (GB), these data are based on autopsy series of these tumors. Reports on MGBs arising from malignancies other than malignant melanoma and renal cell carcinoma are usually in the form of single case reports [4,5] .…”