Renal Cell Carcinoma in the Solitary Kidney: Report of Six Cases1

Abstract

TWENTY-ONE cases of renal cell carcinoma in a solitary kidney have appeared in the literature. Six additional cases are being reported. The chief interest of these tumours lies in their unpredictable biological behaviour which sometimes impels the urologist to exert unorthodox methods of surgical attackNo. 011-63-23, a 52-year-old Caucasian man, had intermittent hamaturia for 18 months. When blood first appeared investigation suggested congenital absence of the left kidney and an enlarged right kidney. A kidney needle biopsy was performed by the referring urologist and this showed hypernephroma. The patient had lost 15 lb. in weight. There were no pathological findings in the chest, but in the right upper abdomen there was a slightly tender and movable round mass.Urinalysis showed two to three red blood cells per high-powered field; the sedimentation rate was 32 mm. per hour. P.S.P. in 30 minutes was 35 per cent.An arteriogram confirmed absence of the left kidney and in the lower half of the right kidney the architecture was distorted by a mass which was not richly vascularised and which failed to show " tumour laking ". Skeletal survey showed no metastases. A retrograde pyelogram disclosed distortion of the right calyceal system by a mass occupying the entire half of the right kidney. Exploration proved involvement of the kidney by a large clear cell carcinoma which had spread to lymph nodes in the pericaval chain. No attempt was made t o resect the tumour. Silver clips were applied to the mass to direct radiation therapy. The patient had an uneventful post-operative recovery and radiation therapy to the right kidney region was started 10 days after his operation. He received a series of 17 treatments with Cobalt 60 teletherapy (3,500 rads).Therapy was discontinued because of anorexia and malaise. Three months later his N.P.N. was found to be 63 mg. per 100 ml., blood urea nitrogen was 35 and creatinine 3.7.The patient lived for one and one-half years following his operation and radiotherapy, finally succumbing to carcinoma spread.Case 2.-F. S., V.A. No. 2571, a 51-year-old Caucasian man, complained of blood in the urine and right flank pain. The symptoms first occurred eight months prior to admission at which time an intravenous urogram showed absence of the left kidney and a stone in the right ureter. The calculus was removed cystoscopically. Seven additional hospitalisations were required because of hamaturia and right flank pain. Two weeks prior