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KMID : 0378019730160010089
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New Medical Journal
1973 Volume.16 No. 1 p.89 ~ p.100
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Primary Adenocarcinoma of the Kidney among Koreans
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Abstract
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Fifteen cases of primary adenocarcinoma of the kidney proved by histologic examination in the Department of Pathology and Urology, Yonsei University College of Medicine from Jan., 1960 to Oct., 1972 are recorded and the literature is reviewed because of the rarity of cases and paucity of reports especially on the histopathology of this neoplasm occurring in Koreans.
Among fifty three cases of renal neoplasm observed in this series, forty eight were malignant, of which only five were secondary, and five were benign. Forty three primary renal malignancies were classified histopathologically into fifteen (34.9%) adenocarcinomas, seventeen (39.5%) Wilm´s tumors, nine (20.9%) carcinomas arising from the renal pelvis and two (4.7%) others, a sarcoma and a carcinosarcoma. Primary renal malignancy was very rare, only 0. 54% of 7992 malignancies reported during the same period in this department, and the rarity seemed to be due to the low occurrence of adenocarcinoma, althougth Wilm´s tumor occurred slightly more often compared to that of the foreign literature.
Of the fifteen adenocarcinomas ten were males and five were females, and the average age vas 57.9 years in male, 49.0 in female and 54.9 in all. Left Kidney was affected in twelve cases and the rest affected right side of the kidney. Only upper or lower pole was involved in two and four cases respectively acid in eight almost all parenchyme of the kidney was displaced by the tumor; One
specimen was obtained from biopsy.
About the size of tumors only one was less than 200gm in weight of the tumor including the kidney or 5cm in the largest diameter of tumor, five were 200-500 gm and eight were exceed 500gm or lQcm, largely being similar to that of other reports, and involvements of the renal capsule, renal pelvis and/or renal vein thrombosis were noticed with naked eyes in four, seven and two cases respectively.
Histopathologically six cases were composed purely of clear cells, one was of plasmic cells and the remainings were of intermediate or mixed cells of the three. Capillary permeation jof the tumor cells, hemorrhage and necrosis were evident in all of the fifteen cases, but calcification could be seen in only three. Infiltration of lymphocytes, plasma cells and monocytes were observed in nine cases, mostly mild except in two where the infiltrations were moderate to marked. In areas of plasmic cell type, the tumors extended into the surroundings, at least focally, with infiltrative rather than with expansile growth, which was the usual growing pattern found in clear cell types. However the cytologic and histologic findings were not associated with invasion of the renal capsule, or pelvis by the tumor.
Factors, described in the literature, possibly related to unfavorable prognosis were more or less proportional to the size of tumors. Intermediate or mixed cell and plasmic cell types of tumors were all found in more than 200gm or 5cm, calcification was observed only when the tumors were 500gm (or 10cm) or more, and the only case weighing less than 200gm or 5cm showed not any invasion of renal capsule or pelvis both grossly and microscopically. Therfore primary adenocarcinoma of the kidney occurred in Koreans considered not to be significantly different compared to that of Europeans and Americans.
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