Pulmonary resection for metastatic renal adenocarcinoma: pathologic findings and therapeutic value.

Forty-four cases of metastatic renal adenocarcinoma to the lung were studied to assess the efficacy of surgical management and to review the histological criteria for diagnosis. Our data support the role of surgical resection in patients with unilateral pulmonary metastasis. Adverse prognostic features include radiographically multiple lesions and involvement of tracheobronchial lymph nodes. A better survival was associated with extensive tumor necrosis. In patients presenting initially with pulmonary metastases, nephrectomy is indicated only when the metastases are unilateral. The various histological patterns of the neoplasm, and features helpful in differential diagnosis are discussed. An intravenous pyelogram (IVP) is indicated for all patients presenting with clear cell tumors of the lung. In certain cases a renal arteriogram may be necessary to exclude the possibility of a renal primary.