STUDIES ON PULMONARY METASTASIS FROM UROGENITAL MALIGNANT TUMORS

1) Pathological Study

Abstract

1) Studies on 75 autopsy cases of urogenital malignant tumor were performed, especially as to the distributions of their metastases.
The percent incidences of the metastasis in lung, liver, bone, kidney, spleen and lymph node was 63, 41, 37, 19, 9 and 69, respectively.
In cases having pulmonary metastasis, systemic arterial blood stream metastases were fre quently recognized.
Most metastasis of urogenital malignant tumors was of caval type. But metastasis of another type, that is by the route of paravertebral vein (Batson's route), was also seen in cases of prostatic cancer who had bone metastasis at a high incidence (70 per cent).
2) Most pulmonary metastases from urogenital malignant tumors showed multiple and nodulated growth. Solitary pulmonary metastasis was rare. Even in 29 per cent of cases which were considered free from pulmonary metastases by x ray films, macro- and/or microscopical metastases were found out in the lung by autopsical examination.
Sixty two per cent of 47 cases having pulmonary metastases had no clinical symptoms.
3) The existence of tumor cell emboli in pulmonary vessels was considered as pre-metastatic condition. Their emboli were frequently observed in renal cell carcinoma and prostatic sarcoma, but rarely in bladder cancer.
Calibers of the pulmonary vessels including tumor cell emboli and diameters of the emboli, were mainly from 25μto 100μ.
Tumor cell emboli were frequently found in vessels around the tumor metastatic foci.
Venous emboli were more frequent than arterial emboli.
Tumor cell emboli were observed in 74 per cent of 47 cases with pulmonary metastasis, but nothing was observed in cases without pulmonary metastasis.
With the exception of bone metastases, the tumor cell emboli in pulmonary vessels were observed frequently in the cases having systemic arterial blood stream metastases such as liver, kidney and spleen. The tumor cell emboli in pulmonary vessels were observed frequently in the cases having left supraclavicular and pulmonary hilar lymph nodes metastases.
4) Intimal thickening of pulmonary vessels was found in 39 percent of 75 examined cases. In the cases with such an intimal thickening of pulmonary vessels, the tumor cell emboli were frequently observed.