Natural history of renal cell carcinoma: a case with 18 years follow-up.

A 53-year-old woman presented to our hospital with a non-metastatic 4 cm renal mass in the right kidney. The patient rejected treatment, but consented to follow-up observation of her condition. The patient underwent a series of computed tomography scans to monitor the progression of the disease. We were able to observe not only an increase in renal mass size, but also involvement of para-aortic lymph nodes, inferior vena cava, and metastasis to the lung. Eighteen years after diagnosis, the subject was hospitalized and died as a result of complications of the disease. Autopsy showed the pathologic diagnosis of the renal mass to be a grade 2 clear cell carcinoma. The literature contains several papers that describe the natural history of renal masses and carcinomas over short periods; however, prior to our case, no reports existed that detailed long-term progression of renal cell carcinoma (RCC) from initial diagnosis to death. It is necessary to clarify the course that RCC takes due to its unpredictable, indolent nature. This will provide clinicians with better insight into how to manage the disease, decide on treatment options, and improve overall survival.