Spontaneous regression of bone metastasis from renal cell carcinoma; A case report
© Nakajima et al; licensee BioMed Central Ltd. 2006
Received: 29 March 2005
Accepted: 13 January 2006
Published: 13 January 2006
Spontaneous regression of metastatic renal cell carcinoma is rarely observed.
Metastatic renal cell carcinoma was identified in a 70-year-old male using computed tomography-guided percutaneous needle biopsy. Two months after the diagnosis, a partial resection of the sternal bone was performed. Pathological examination revealed granulated tissue with bleeding and necrosis but no carcinogenic cells.
We report a pathologically identified case in which a sternal bone metastasis that was noticed two years after radical nephrectomy regressed completely and spontaneously.
Since the first reported case of spontaneous regression of metastatic renal cell carcinoma in 1928 by Bumpus , it has been known that renal cell carcinoma can regress spontaneously, although the frequency of the phenomenon was estimated to be less than 1%, and most cases were observed after a resection of the primary tumor. The site of the regression was most commonly in the lung. The present case of spontaneous regression of metastasis from renal cell carcinoma to the sternum is the first such case to be reported.
Since Bumpus reported the first case of spontaneous regression of metastatic renal cell carcinoma , the incidence of spontaneous regression has been low, and is thought to be less than 1% of all cases . Challis and Stam reviewed the spontaneous regression of cancer from 1900 to 1987, and found that renal cell carcinoma headed the list of histologically diagnosed conditions that underwent spontaneous regression .
The sites of regression observed in the reported cases included the brain, bone and liver, but the highest incidence was in the lung [4, 5]. In most cases, the tumor regressions were observed following treatments of the primary tumors such as surgical removal, radiotherapy, embolization and radio frequency ablation [4, 6]. It is reported that complete regression is even rarer than partial regression. The duration of tumor regression is variable and recrudescence is sometimes observed . The mechanism of spontaneous regression is still unclear, although immunologic effects have been discussed.
In the present case, early-stage renal cell carcinoma was diagnosed. The patient underwent no tumor-specific treatment for about two years after the nephrectomy. The size of the sternal tumor gradually increased until the percutaneous needle biopsy was performed, but it regressed completely within a mere two months. During these two months, the patient had no chemotherapy or immunotherapy, or any kind of interventional treatment. Complete regression of a metastatic tumor is quite rare especially two years after the resection of the primary tumor. One of the possible explanations of this phenomenon may in this case have been induced by the needle biopsy performed in order to diagnose the metastasis; or bleeding caused by the biopsy may have triggered a chain reaction of host immune responses. The patient is now receiving interferon therapy in our outpatient clinic on individual basis rather than supported by literature data to prevent recurrence of the tumor [7–9]. This is the first reported case of spontaneous regression occurring in a sternal bone metastasis from renal cell carcinoma.
We thank Dr. Hiroaki Kuramochi for his insightful comments preparing this article. We are also grateful to C.W.P. Reynolds for the linguistic assistance with the article.
Written consent was obtained from the patient for publication of the patient's details.
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