Malignant Tumors of the Kidney: Review of 117 Cases

From 1924 to 1940, inclusive, 117 cases of malignant renal neoplasms were seen in the University of Minnesota Hospitals. The follow-up period extended to the end of 1942. In this group there were 94 cases of carcinoma of the renal cortex, 13 cases of Wilms' tumor, 9 cases of carcinoma of the renal pelvis, and one of sarcoma. Historical The first reported case of carcinoma of the renal pelvis was that of Hedenius and Waldenstroem in 1878 in a 79-year-old man. Grawitz in 1882 first described the tumor which bears his name. He recorded a typical case under the name of “struma aberrata suprarenalis” and showed its resemblance to adrenal structure. Harris in the same year described an adrenal-like tumor of the kidney, which he called “alveolar sarcoma of the renal capsule.” Rokitansky, in his textbook, in 1861, gave what Newcomb states is a clear description of a Grawitz tumor. Later Birch-Hirschfeld introduced the term “hypernephroma.” At first, most investigators accepted the Grawitz theory of the suprarenal derivation of this tumor, but in 1908 Stoerck brought forth his findings favoring a renal rather than a suprarenal origin. From that time on the controversy has raged, and even to this day there is not unanimous agreement. At the present time the consensus seems to be definitely in favor of a renal origin. The first accurate description of a mixed tumor of the kidney was apparently given by Eberth in 1872. Prior to that time all malignant tumors of the kidney were thought to be carcinomas. Eberth believed these tumors came from inclusions of the wolffian body because of the presence in it of embryonal muscle cells, which he thought accounted for the presence of striated muscle fibers in the tumor. Other investigators, however, later showed these to be non-striated muscle fibers. Cohnheim in 1875 and Ribbert in 1886 attributed the origin of these tumors to aberrant germ plasm. In 1894 Birch-Hirschfeld reviewed the literature and agreed with Eberth that the origin is in the wolffian body. He suggested the term “adenomyosarcoma” for these mixed kidney tumors. Wilms in 1894 wrote his classic monograph in which he presented the theory of origin that is generally accepted today. He believed the anlage of the tumor to be a fragment of primitive, undifferentiated mesodermal tissue of the type which gives rise to the myotome (source of striated muscle), the sclerotome (source of vertebral anlage) , the nephrotome (wolffian body anlage), and the mesenchymal tissue from which smooth muscle takes its origin. Busse in 1899 disagreed with Birch-Hirschfeld, stating that remnants of the wolffian body are not found in the kidney. He and Muus thought that the tumor arose from a segregated portion of renal blastema which failed to develop normally. Frazer in 1920 summarized the modern views of its origin.