Symptomless renal tumours diagnosed from their metastases

After a brief review of renal tumours diagnosed on the basis of metastases, two cases are described in which subcutaneous formations believed to be lipomas were metastases of symptomless hypernephromas. One case was diagnosed early on basis of the histological finding. The primary tumour could be localized only by angiography. After nephrectomy and resection of the contralateral rib and pleura, the patient was free of symptoms for one year. In the subsequent year a pathologic subtrochanteric fracture called attention to a new metastasis. After laminar osteosynthesis function of the hip and knee joints was satisfactory and so has been the general condition ever since the first operation now for three years. In the second case, the knot assumed to be a lipoma was removed but no histological examination was carried out. These experiences have induced the authors to call attention to the importance of histological examination of apparently banal lesions and to the considerable survival which can be achieved in these patients.