|Year : 2013 | Volume
| Issue : 1 | Page : 94-95
Collecting duct carcinoma: A rare malignancy
Debdas Bose1, Ram N Das2, Uttara Chatterjee2, Uma Banerjee3
1 Department of Pathology, Calcutta Medical College, Kolkata, India
2 Institute of Postgraduate Medical Education and Research, Kolkata, India
3 Burdwan Medical College and Hospital, Burdwan, West Bengal, India
|Date of Web Publication||10-Apr-2013|
Ram N Das
265, Purba Sinthee Bye Lane, Kolkata- 700030, West Bengal
Source of Support: None, Conflict of Interest: None
A 45-years old man complained of hematuria, and subsequent examination and ultrasonography revealed a mass in the left kidney. Nephrectomy was performed and macroscopically an ill-defined pale-cream, irregular mass was identified which occupied predominantly the renal medulla. Histopathologic examination showed slit like tubular ducts lined by atypical cuboidal to polygonal cells and a marked desmoplastic stromal reaction. The diagnosis of collecting duct carcinoma was made. Patient is now doing well after 11 months of follow up.
Keywords: Collecting duct carcinoma, hematuria, kidney
|How to cite this article:|
Bose D, Das RN, Chatterjee U, Banerjee U. Collecting duct carcinoma: A rare malignancy
. J Can Res Ther 2013;9:94-5
| > Introduction|| |
Collecting duct carcinoma (CDC) is rare and comprises less than 1% of renal epithelial tumors,  that affects younger patients.  It arises from the epithelium of Bellini's ducts, in the distal portion of the nephron. It is important to differentiate this from other renal tumors as it behaves in a more aggressive fashion and is associated with aggressive regional and distant spread.  Clinically, CDC appears as a renal mass often accompanied by flank pain and hematuria and is frequently mistaken for RCC or transitional cell carcinoma of the renal pelvis.  We came across one such case in a man of 45 years. The detail of the case is described below.
| > Clinical Summary|| |
A man of 45 years presented at our Urology OPD, with complains of hematuria for 1 month. On examination he was found to have pallor and right-sided abdominal lump. Imaging studies (USG & CT scan) showed enlarged right kidney with a space-occupying lesion suggestive of renal neoplasm. X-ray thoraco-lumbar spine and radionucleotide whole body bone scan did not reveal any metastatic disease. He underwent nephrectomy at our hospital.
| > Pathological Findings|| |
On gross examination the kidney measured 12 . 5 × 9 × 8 cm. On slicing, it had an ill-defined pale cream irregular mass measuring 6 × 5 × 3 cm, which centered on the renal medulla, there was no extension to the renal cortex. On microscopic examination, the sections taken from the mass show the tumor was composed of irregular slit like tubular ducts and cords of cells in an abundant loose slightly basophilic stroma. The cells showed the features of atypia with moderate degree of nuclear pleomorphism and thick nuclear membranes. The cells were cuboidal to polygonal and projecting into the tubular lumen. The cells had moderate amount of cytoplasm. There was prominent desmoplastic stromal reaction surrounding the glands. The neoplastic glands were seen trapped within the surrounding the renal parenchyma, which showed the feature of inflammation. Based on these features, a diagnosis of collecting duct carcinoma was made [Figure 1] and [Figure 2].
|Figure 1: Photomicrograph showing low power view of the tumor with neoplastic ducts lying in a desmoplastic stroma with entrapped glomeruli. (H/E)|
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|Figure 2: Histopathology of the same figure showing angulated slit like glands, lined by atypical cells projecting into the lumen. (H/E)|
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| > Discussion|| |
The first description of collecting duct carcinoma is attributed to Mancilla-Jimenez R et al.,  who described three cases of papillary renal cell carcinoma in which there was atypical hyperplastic changes in collecting duct epithelium. It is designated as carcinoma of collecting duct of Bellini by the World Health Organization.  It may occur at any age; the mean age of presentation is approximately 53 years, with a range of 13 to 83 years and it tends to affect younger population. , Hematuria is the most common presentation followed by pain abdomen, weight loss and the presence of palpable mass. Our patient was of 45 years and he also presented with hematuria. The aggressive nature of most of this tumor is evidenced by the fact that more than 50% cases present with metastatic disease. , But on investigation there was no evidence of metastasis in our case.
It usually arises within the collecting duct of the renal medulla with a firm consistency and gray white in color. These features were also present in our case. Microscopically it is usually tubular or tubulopapillary with high nuclear grade and markedly desmoplastic stroma. The complex tubules and papillae are lined by tumor cells with eosinophilic, basophilic or amphophilic cytoplasm with high-grade nuclei and prominent nucleoli with focal spindle cell differentiation. It may contain foamy macrophage lining papillae and acute or chronic inflammatory cells infiltration in surrounding stroma. Rarely it can be frankly sarcomatoid. Characteristically dysplastic or neoplastic cells can be present within adjacent renal tubules. Cytoplasmic and luminal mucin is characteristic of this tumor and is a distinguishing feature, as mucin is not produced in renal cell carcinoma. , Any high-grade renal cell carcinoma, urothelial carcinoma, metastatic carcinoma, which infiltrates the collecting duct, may mimic collecting duct carcinoma. The presence of papillae or in-situ component in the renal pelvis, invasion as solid nest with stratified epithelium, absence of intraparenchymal papillary component would support urothelial origin.  Immunohistochemically it expresses peanut lectin agglutinin, Ulex europaeus agglutinin, high molecular weight cytokeratin, and vinculin which have been proposed as an immunohistochemical marker.  Cytogenetically this tumor shows loss of heterozygosity and deletion of 1q32.1-32.2, and monosomy of chromosomes 1, 6, 14,and 22 but trisomy 7/17 or loss of chromosome 3 are not seen, which are found in papillary renal cell carcinoma and clear cell carcinoma kidney.  Clinical outcomes are poor, with approximately 66% of patients dying of disease within 2 years of diagnosis.  Our patient is doing well on 11 months follow up till now.
| > References|| |
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[Figure 1], [Figure 2]