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Familial Tendency to Renal Carcinoma
FAMILIAL TENDENCY TO RENAL CARCINOMA PRESTON NOWLIN From the Nalle Clinic, Charlotte, N. C.
The increased incidence of some types of malignant tumors in certain families has often been noted. A familial tendency to renal malignancy seems to be unusual, none having been found in a comprehensive review of the literature. The following case reports are those of 2 brothers, each dying of malignant tumor of the kidney, and with a family history that strongly suggests the death of a sister from the same cause.
Case 1. G. A. L., a white man, aged 67, was admitted to St. Peters Hospital September 4, 1933. He had had pain in the left flank and hematuria of 2 weeks' duration. There had also been marked frequency of urination. There was no history of chills, temperature elevation, or passage of stone. The patient had felt well up to the present illness, except for a feeling of general weakness of 6 months' duration. The past medical history revealed nothing of significance. Three brothers and 4 sisters were living and well. One sister died of cancer of the cervix at the age of 50. The father died of pulmonary tuberculosis, the mother of cerebral hemorrhage. Another sister, at the age of 54, had been ill for 3 years, and complained of a large growth in the right renal region, and frequently passed bloody urine. A nephrectomy was done in 1910 and the attending surgeon told the family that the kidney was the seat of a malignant tumor . She died a few months following operation. (Unfortunately the hospital records of this case are not available.) Both maternal and paternal grandparents lived to advanced ages, their deaths not being due to malignant disease or any disease of the genito-urinary system. No other incidences of renal disease are known to exist in any of the family branches. The patient was a well developed man, who appeared acutely ill. The temperature was 100 F., the pulse rate 100. Examination of the head and neck and chest showed no abnormality. The abdomen was flat. There was a large, irregular, tender mass palpable in the left kidney region, that extended downward and forward below the level of the umbilicus. Rectal examination was negative. The hemoglobin was 70, the red blood cells 4,560,000, and the blood Wassermann negative. The urine showed a heavy trace of albumin and many pus cells and erythrocytes. On cystoscopy the urethra was normal, the bladder was acutely inflamed. Bloody urine was seen emerging from the left ureteral orifice. No. 6 catheters 654
FAMILIAL TENDENCY TO RENAL CARCINOMA
655
were passed easily up both ureters. Indigo-carmine appeared from the right ureter in heavy concentration in 5 minutes, none appeared from the left ureter in 30 minutes. A left pyelogram showed complete obliteration of the superior calyx. The middle calyx was compressed apparently by a soft tissue mass above. There was a huge soft tissue mass extending up to the twelfth rib. Films of the chest showed no variation from normal. On September 7, 1933, a left nephrectomy was done under gas-ether anesthesia. The patient made an uneventful recovery and left the hospital in 15 days. Death occurred 2 months later from pulmonary metastases. The kidney measured 15 cm. x 10 cm. x 5 cm. Practically the entire kidney substance is taken up with a friable tumor mass that contained numerous alveolar-like compartments. At the upper pole there was a small area of normal secreting kidney tissue. The tumor was apparently confined to the capsule except in 1 area near the lower pole. Sections showed large areas of necrotic material, numerous areas of extravasated blood, and areas of pale epithelial cells having alveolar arrangements. The cells and their arrangement were typical of hypernephroma. (H.P. Barrett.) Case 2. V. A. L., aged 62, a brother of G. A. L., was first seen at the N alle Clinic July 7, 1934, complaining of hematuria. Sixty days prior to this, he had had a severe, agonizing pain in the right flank radiating to the right testicle. Since that time he had constantly noted blood in his urine. There had been some slight dysuria. He had lost 22 pounds in the last 2 months. The past history was essentially negative. The patient did not appear to be acutely ill. The temperature was 99 F., the pulse rate 80. Examination of the head, neck, and chest showed no abnormality. On abdominal examination the right kidney was palpable, slightly enlarged and tender. There was a large right inguinal hernia. On rectal examination there was a slight degree of prostatic enlargement but no evidence of malignancy. On cystoscopy the urethra and bladder were normal, and there was no residual urine. There was a slight lateral lobe hypertrophy. No. 6 catheters passed easily to either kidney. Indigo-carimine intravenously, appeared from the right ureter in 10 minutes in good concentration, and from the left ureter in 3 minutes. The urine from the right kidney was grossly bloody while that from the left was clear. The urogram showed elongation and compression of the lower and middle calices due to a mass involving the lower half of the right kidney. The blood Wassermann was negative. The red cells were 3,200,000 per c. mm., the hemoglobin was 65. The urine contained many blood cells but no albumin nor pus. The patient refused all treatment and died 2 months later from pulmonary metastases and cachexia.
412 N. Church St., Charlotte, N. C.
The increased incidence of some types of malignant tumors in certain families has often been noted. A familial tendency to renal malignancy seems to be unusual, none having been found in a comprehensive review of the literature. The following case reports are those of 2 brothers, each dying of malignant tumor of the kidney, and with a family history that strongly suggests the death of a sister from the same cause.
Case 1. G. A. L., a white man, aged 67, was admitted to St. Peters Hospital September 4, 1933. He had had pain in the left flank and hematuria of 2 weeks' duration. There had also been marked frequency of urination. There was no history of chills, temperature elevation, or passage of stone. The patient had felt well up to the present illness, except for a feeling of general weakness of 6 months' duration. The past medical history revealed nothing of significance. Three brothers and 4 sisters were living and well. One sister died of cancer of the cervix at the age of 50. The father died of pulmonary tuberculosis, the mother of cerebral hemorrhage. Another sister, at the age of 54, had been ill for 3 years, and complained of a large growth in the right renal region, and frequently passed bloody urine. A nephrectomy was done in 1910 and the attending surgeon told the family that the kidney was the seat of a malignant tumor . She died a few months following operation. (Unfortunately the hospital records of this case are not available.) Both maternal and paternal grandparents lived to advanced ages, their deaths not being due to malignant disease or any disease of the genito-urinary system. No other incidences of renal disease are known to exist in any of the family branches. The patient was a well developed man, who appeared acutely ill. The temperature was 100 F., the pulse rate 100. Examination of the head and neck and chest showed no abnormality. The abdomen was flat. There was a large, irregular, tender mass palpable in the left kidney region, that extended downward and forward below the level of the umbilicus. Rectal examination was negative. The hemoglobin was 70, the red blood cells 4,560,000, and the blood Wassermann negative. The urine showed a heavy trace of albumin and many pus cells and erythrocytes. On cystoscopy the urethra was normal, the bladder was acutely inflamed. Bloody urine was seen emerging from the left ureteral orifice. No. 6 catheters 654
FAMILIAL TENDENCY TO RENAL CARCINOMA
655
were passed easily up both ureters. Indigo-carmine appeared from the right ureter in heavy concentration in 5 minutes, none appeared from the left ureter in 30 minutes. A left pyelogram showed complete obliteration of the superior calyx. The middle calyx was compressed apparently by a soft tissue mass above. There was a huge soft tissue mass extending up to the twelfth rib. Films of the chest showed no variation from normal. On September 7, 1933, a left nephrectomy was done under gas-ether anesthesia. The patient made an uneventful recovery and left the hospital in 15 days. Death occurred 2 months later from pulmonary metastases. The kidney measured 15 cm. x 10 cm. x 5 cm. Practically the entire kidney substance is taken up with a friable tumor mass that contained numerous alveolar-like compartments. At the upper pole there was a small area of normal secreting kidney tissue. The tumor was apparently confined to the capsule except in 1 area near the lower pole. Sections showed large areas of necrotic material, numerous areas of extravasated blood, and areas of pale epithelial cells having alveolar arrangements. The cells and their arrangement were typical of hypernephroma. (H.P. Barrett.) Case 2. V. A. L., aged 62, a brother of G. A. L., was first seen at the N alle Clinic July 7, 1934, complaining of hematuria. Sixty days prior to this, he had had a severe, agonizing pain in the right flank radiating to the right testicle. Since that time he had constantly noted blood in his urine. There had been some slight dysuria. He had lost 22 pounds in the last 2 months. The past history was essentially negative. The patient did not appear to be acutely ill. The temperature was 99 F., the pulse rate 80. Examination of the head, neck, and chest showed no abnormality. On abdominal examination the right kidney was palpable, slightly enlarged and tender. There was a large right inguinal hernia. On rectal examination there was a slight degree of prostatic enlargement but no evidence of malignancy. On cystoscopy the urethra and bladder were normal, and there was no residual urine. There was a slight lateral lobe hypertrophy. No. 6 catheters passed easily to either kidney. Indigo-carimine intravenously, appeared from the right ureter in 10 minutes in good concentration, and from the left ureter in 3 minutes. The urine from the right kidney was grossly bloody while that from the left was clear. The urogram showed elongation and compression of the lower and middle calices due to a mass involving the lower half of the right kidney. The blood Wassermann was negative. The red cells were 3,200,000 per c. mm., the hemoglobin was 65. The urine contained many blood cells but no albumin nor pus. The patient refused all treatment and died 2 months later from pulmonary metastases and cachexia.
412 N. Church St., Charlotte, N. C.