Tomohiro Shiramizu

Metastatic Processes and a Potential Indication of Treatment for Metastatic Lesions of Renal Adenocarcinoma

Renal adenocarcinoma findings from 307 autopsied cases with metastasis to 1 and 2 organs were investigated concerning the mode of metastasis. The lung was the most frequent site of metastasis to 1 organ, although the frequency was rather low (30 per cent), followed by bones (over-all), lymph nodes (over-all) and brain, and involving frequently the thoracic spine and retroperitoneal lymph nodes. In patients with metastases to 2 organs a significant correlation was found between the pulmonary-tracheal lymph nodes and those to the lungs. Potential indications for treatment of metastatic lesions were 1) lymphadenectomy and/or radiation therapy for the retroperitoneal and para-aortic lymph nodes and 2) resection of metastatic lesions in the lungs combined with lymphadenectomy and/or radiation therapy for the pulmonary-tracheal lymph nodes. In patients without lung metastasis lymphadenectomy and/or radiation therapy for the pulmonary-tracheal lymph nodes is not always necessary.

Age changes in metastatic patterns in renal adenocarcinoma

The metastatic pattern in primary renal adenocarcinoma with respect to age has been studied by analyzing the necropsy records of 1828 patients. Metastasis‐free cases were noticeably frequent in the patients over 70 years of age. The metastatic pattern varied with age and was classified grossly into four types according to the age‐associated change in frequency: (1) diminishing; (2) increasing; (3) peaked; and (4) invariable. The incidence of hematogenous metastases showed little or no relation to advancing age whereas dissemination, which was possibly lymphogenous, was found to diminish as the age advanced, the latter trend being especially conspicuous in patients with lymph nodes distant from the primary lesion. It has been inferred that organs displaying comparable tendencies of age‐associated change in frequency of metastasis may share the same route of dissemination.