Carcinoma of the kidney

Abstract

SRSIOR SURGEDE, ROYAl. HOSPITAL, SHISFPIELI). SIWE the c4assical papcr by Grawitz in 1883, much has been written on thc diagnosis of renal hypcrnephroma and on the vexed question of its pathology ; this is probably the reason that the interest shown in the other neoplasms has suffered from a temporary cclipsc.A study of the literature proves that. though carcinoma of the kidney is recognized as a sufficiently well defined form of renal growth, its description is limited usually t o specinicns obtained by opcration or a t autopsy, and littlc or no attempt is made t o distinguish it clinically.I n u recent tcxt-book on surgical pathology the author divides rcnal growths into two groups : the hgpernephroma or Grawit: type and the embrgoniu or Wilnts typc, and he states that " It will be found that the vast majority of tumours encountered in actual practice can be placed in one or other of these groups ".Whilst it is unlikely that many cases of carcinoma of the kidney will come within the kcn of any gcncral surgeon, recent experience has convinced mc that these tuniours arc far from uncommon ; moreover, they may present certain quite characteristic symptoms, the recognition of which is of great importance ; otherwise, some patients mill undergo a dangerous and unnecessary opcration.Uef' oorc discussing the symptoms incidental t o this form of growth and the complications peculiar t o it, I will give thc history of a case in which I was able t o make such u diagnosis and t o predict. with some awuracy, the future of the patient.In my opinion such a statement is misleading. CASE REPORT.iMrs. I%., aged 60. In October, 1930, I was asked to see her for subacute jntedinel obstruction ; she had been poorly since June and had complained of constant sekere pain in the back.She was admitted to a nursing home, where a turpentine enema at once relieved the obstruction, which was obviously due to fzcal impaction : a barium enema aas then given and the colon shown to bc normal.On going more closely into her history, she recalled that, 5ome two years before this, she had sutkred from a sharp hzematuria which had continued for scveral days. Her medical man was just about to ask me to see her when the bleeding ceased, tlic consultation was cancelled, and thc patient went away for a holiday. She had ncwr noticed blood in her urinc sincc that one occasion.The distension of the abdomen had now subsided, and I again examined hcr, but I was unable to feel either kidney and there was no tenderness in either loin. The urine wa5 clear and contained neither blood nor pus, but therc was a wcllmarked cloud of albumin.I now ventured t o suggest t o her doctor that this woman was suffering froin a carcinoma of the kidney. though which organ was affected I could not qay : that :I