Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 758 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
CASE REPORT  
Year : 2012  |  Volume : 23  |  Issue : 4  |  Page : 810-812
Collecting duct carcinoma: A rare renal tumor


IPGMER, Kolkata, India

Click here for correspondence address and email

Date of Web Publication9-Jul-2012
 

   Abstract 

The most common primary malignant renal tumor is renal cell carcinoma (RCC), which accounts for 3% of all adult malignancies. Bellini duct carcinoma or collecting duct carcinoma is an unusual rare variant of RCC. This histologically distinct tumor is very rare, with less than 100 cases reported in the literature, and accounts for approximately 1% of all malignant renal epithelial tumors. We report two cases of collecting duct carcinoma and highlight the rarity of these tumors and their similarity to RCC.

How to cite this article:
Bansal P, Kumar S, Mittal N, Kundu AK. Collecting duct carcinoma: A rare renal tumor. Saudi J Kidney Dis Transpl 2012;23:810-2

How to cite this URL:
Bansal P, Kumar S, Mittal N, Kundu AK. Collecting duct carcinoma: A rare renal tumor. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Dec 4];23:810-2. Available from: https://www.sjkdt.org/text.asp?2012/23/4/810/98166

   Introduction Top


The most common primary malignant renal tumor is renal cell carcinoma (RCC), which accounts for 3% of all adult malignancies. A rare variant of RCC is collecting duct carci­noma of the kidney. This histologically dis­tinct tumor is very rare, with less than 100 cases reported in the literature, and accounts for approximately 1% of all malignant renal epithelial tumors. [1],[2],[3] We report two cases of collecting duct carcinoma in order to highlight its rarity as well as its similarity to RCC.


   Case Reports Top


Case 1

A 45-year-old male presented with intermittent painless gross hematuria and loss of weight of one-month duration. Clinical examination and renal functions were normal. Renal ultrasonogram (USG) showed an irregular space-occu­pying lesion (SOL) in the mid-polar region of the left kidney with mild hydronephrosis. Com­puterized tomography (CT) scan showed an irregular enhancing soft tissue mass in the left kidney. No retroperitoneal lymphadenopathy was seen [Figure 1].
Figure 1: Microscopic examination of the tumor showing atypical epithelial cells with large vascular nuclei and prominent nucleoli (HE 200). Inset – computerized tomography showing enhancing left renal tumor.

Click here to view


The patient was subjected to left radical nephrectomy. On gross examination, the resected kidney showed a central grayish-white growth at the mid-polar region extending into the renal pelvis. Microscopically, the features were sug­gestive of collecting duct carcinoma pene­trating the capsule of the kidney at one area and peri-nephric and hilar fat in some other areas [Figure 1]. The patient developed lung and bone metastases six months after surgery and died three months later.

Case 2

A 50-year-old man presented with painless hematuria lasting for two months. Renal USG showed an irregular SOL in the upper pole of the right kidney. Computerized tomography scan showed a large enhancing tumor in the superior pole of the right kidney, spreading to the renal pelvis. No retroperitoneal lymphadenopathy was seen. Right radical nephrectomy was performed. An ill-defined, pale cream-colored irregular mass measuring approximately 6 cm was seen. Microscopic examination showed features of collecting duct carcinoma [Figure 2]. The patient developed bone metas­tasis at six months, and died nine months after surgery.
Figure 2: Microscopic examination showing collecting duct carcinoma with tubular and capillary growth pattern.

Click here to view



   Discussion Top


Bellini duct carcinoma or collecting duct car­cinoma is an unusual rare variant of RCC. It was established as a distinct entity in 1986 by Fleming and Lewi, who defined it as a me­dially located, highly aggressive tumor with mixed solid and tubulopapillary patterns and an infiltrating tubular component eliciting a marked desmoplastic reaction. [4] In the interna­tional classification of tumors by the World Health Organization (WHO) in 1981, it has been grouped with RCC with the sub-desig­nation "Bellini duct carcinoma." [5]

Collecting duct carcinoma has now been recognized as a separate entity, and the latest WHO classification designates it as a distinct type. [6] This histologically distinct tumor is very rare, with less than 100 cases reported in the literature, and accounts for approximately 1% of all malignant renal epithelial tumors. [1],[2],[3],[4],[5],[6] This type of renal carcinoma became charac­terized as an aggressive tumor, often presen­ting clinically with hematuria, symptoms rela­ted to an abdominal mass or distant metas­tases. Originating in the renal medulla and secondarily extending into the cortex, collec­ting duct carcinomas are generally regarded as high-grade neoplasms expressing phenotypic markers of the normal collecting duct. The most specific of these include Ulex europaeus-1 lectin (UEA-1), peanut agglutinin (PNA) and high molecular weight cytokeratin (HMWK, 34+E12). [2],[3],[7]

Collecting duct carcinoma is usually clini­cally aggressive, with 40% of the patients having metastatic disease at presentation. [1],[2] Metastases to different organs have been re­ported, including bone and leptomeninges. [1],[2],[8] Bone metastases usually are osteoblastic. [2] In our cases, both patients developed osteolytic secondaries.

The majority of reported patients were treated by radical nephrectomy and regional lymph node dissection. Immunoactive agents such as interferon or interleukin and combination che­motherapy for relapsed desease or metastatic lesions usually seem to be ineffective. [1] At present, the number of reported cases of collecting duct carcinoma is too small and with a short follow-up to make any real sur­vival assessment. However, the cases reported point to poor prognosis with average survival of approximately 12 months only. [9]

 
   References Top

1.Zambrano NR, Lubensky IA, Marino MJ, Linehan WM, Walther MM. Histopathology and molecular genetics of renal tumors: Toward unification of a classification system. J Urol 1998;162:1246-58.  Back to cited text no. 1
    
2.Dimopoulos MA, Logothetis CJ, Markowitz A, Sella A, Amato R, Ro J. Collecting duct carci­noma of the kidney. Br J Urol 1993;71:388-91.  Back to cited text no. 2
[PUBMED]    
3.Kennedy SM, Marino MJ, Linehan WM, Roberts JR, Robertson CN, Neumann RD. Collecting duct carcinoma of the kidney. Hum Pathol 1990;21:449-56.  Back to cited text no. 3
    
4.Fleming S, Lewi HJ. Collecting duct carcinoma of the kidney. Histopathology 1986;10:1131-41.  Back to cited text no. 4
[PUBMED]    
5.Mostofi FK, Sesterhenn IA, Sobin LH. Histological typing of kidney tumours. In: Interna­tional histologic classification of tumors, No. 25. Geneva: WHO; 1981.  Back to cited text no. 5
    
6.Mostofi FK, Davis CJ, Sobin LH. Histologic typing of kidney tumours. International Histologic Classification of Tumours. No. 25. Geneva: World Health Organization; 1998.  Back to cited text no. 6
    
7.Kacso G, Akhtar M, Beckwith BJ, et al. The Heidelberg classification of renal cell tumors. J Pathol 1997;183:131-3.  Back to cited text no. 7
    
8.Olivere JW, Cina SJ, Rastogi P, Ro YJ. Collecting duct meningeal carcinomatosis. Arch Pathol Lab Med 1999;123:638-41.  Back to cited text no. 8
    
9.Chao D, Zisman A, Pantuck AJ, et al. Collec­ting duct renal cell carcinoma: Clinical study of a rare tumor. J Urol 2002;167:71-4.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Punit Bansal
IPGMER, Kolkata
India
Login to access the Email id


DOI: 10.4103/1319-2442.98166

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Collecting duct carcinoma of the kidney: a clinicopathological study of five cases
Xiangyang Wang,Jianwei Hao,Ruijin Zhou,Xiangsheng Zhang,Tianzhong Yan,Degang Ding,Lei Shan,Zhonghua Liu
Diagnostic Pathology. 2013; 8(1): 96
[Pubmed] | [DOI]
2 Collecting duct carcinoma of the kidney: A clinicopathological study of five cases
Wang, X. and Hao, J. and Zhou, R. and Zhang, X. and Yan, T. and Ding, D. and Shan, L. and Liu, Z.
Diagnostic Pathology. 2013; 8(1)
[Pubmed]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
   Introduction
   Case Reports
   Discussion
    References
    Article Figures
 

 Article Access Statistics
    Viewed3137    
    Printed84    
    Emailed0    
    PDF Downloaded576    
    Comments [Add]    
    Cited by others 2    

Recommend this journal