Synchronus renal cell carcinoma and Bellini duct carcinoma: a case report on a rare coincidence

Detection of two synchronous histologically different renal cell carcinoma subtypes in the same kidney: a case report and review of the literature

INTRODUCTION

Renal cell carcinoma (RCC) is the dominant primary renal malignant neoplasm, encompassing a significant portion of renal tumors. The presence of synchronous yet histologically distinct ipsilateral RCCs, however, is an exceptionally uncommon phenomenon that is rather under-described in the literature regarding etiology, diagnosis, management, and later outcomes during follow-up.

CASE PRESENTATION

We aim to present the 9th case of a combination chromophobe RCC (ChRCC) and clear cell RCC (ccRCC) in literature, according to our knowledge, for a 69-year-old North African, Caucasian female patient who, after complaining of loin pain and hematuria, was found to have two right renal masses with preoperative computed tomography (CT) and underwent right radical nephrectomy. Pathological examination later revealed the two renal masses to be of different histologic subtypes.

CONCLUSION

The coexistence of dissimilar RCC subtypes can contribute to diverse prognostic implications. Further research should focus on enhancing the complex, yet highly crucial, preoperative detection and pathological examination to differentiate multiple renal lesions. Planning optimal operative techniques (radical or partial nephrectomy), selecting suitable adjuvant regimens, and reporting long-term follow-up outcomes of patients in whom synchronous yet different RCC subtypes were detected are of utmost importance.

A huge collecting duct carcinoma of the kidney in an elderly woman: Diagnosis and managment challenge (uncommon condition)

Collecting duct carcinoma, also known as Bellini duct carcinoma (BDC) is a rare type of renal tumor, arising from the distal collecting ducts. The prognosis of this disease is extremely poor due to its rapid progression with widespread metastasis. The present study reported a case of CDC involving the left renal region of a 68-year-old female patient.

CT scan showed a huge mass occupying the lower portion of the left kidney. The patient underwent enlarged nephrectomy. Anatomopathological examination showed collecting duct carcinoma of the kidney. Patient's evolution was exceptionally favorable: no recurrence, no locoregional metastasis and no distant metastasis.

Collecting duct carcinoma of kidney: Masquerading as genitourinary tuberculosis - Lessons learnt

We present a case of Collecting duct of Bellini carcinoma (CDC) which was masquerading as Genitourinary Tuberculosis/chronic granulomatous disease in a 43 year old women, who presented with complaints of low grade fever, loss of appetite, left loin pain and dyspnoea with recent onset of haemoptysis. After extensive evaluation, she was referred to urology where she underwent a laparoscopic assisted open left radical nephrectomy which was reported to be Collecting duct carcinoma.This case is being presented for the diagnostic dilemma it elicited throughout the evaluation.

A Renal Cancer with Intermediate Characteristics between Collecting (Bellini) Duct Carcinoma and Urothelial Carcinoma: Case Report and Review of the Literature

Collecting duct carcinoma of the kidney is a rare and aggressive neoplasm of the distal collecting tube, often metastatic at the time of the diagnosis, for which there is no established therapy. We herein describe the case of a 65-year-old man with a renal cancer with a particular immunohistochemical pattern and pathologic aspect. The lesion was diagnosed as a tumor borderline between a urothelial carcinoma with intraductal spreading and a collecting duct carcinoma with caly-ceal and pelvic spreading. The patient is disease-free 11 months after diagnosis, after radical surgery with adjuvant chemotherapy (carboplatine and gemcitabine) and radiotherapy of a local recurrence. Owing to the common embryologic origin of collecting duct and transitional urothelial cells, several authors have reported an association between collecting duct carcinoma and urothelial cancer. The literature is reviewed to evaluate drugs active against urothelial cancer (like ifosfamide, paclitaxel, carboplatin and gemcitabine). This field should be investigated in the future, in the framework of a neoadjuvant or adjuvant chemotherapy able to support radical surgery for local and advanced collecting duct carcinoma.

Aggressive co-existence: Collecting duct and clear cell carcinoma in the same kidney

As in every organ, synchronous multiple cancers are rarely encountered in kidneys. In the literature, mostly co-existence of renal cell carcinoma and transitional cell carcinoma was reported. In the literature, the co-existence of collecting duct carcinoma and clear cell carcinoma was described only for a few cases with different patterns. With these two cases, we aimed to present a very rare entity with synchronous existence of clear cell renal cell carcinoma and collecting duct carcinoma in the same kidneys.

Bellini's duct carcinoma: A report of two cases and a review of the literature

Bellini's duct carcinoma (BDC) is a rare and aggressive variant of renal cell carcinoma that possesses an extremely poor prognosis. The greater the grade or stage of disease, the poorer the prognosis tends to be. This study presents two cases of BDC; one case of low grade BDC and one case of high grade BDC in a 47-year-old male and 74-year-old female, respectively. The 47-year-old male patient presented with painless gross hematuria, which had lasted for 3 weeks and subsequently underwent purely laparoscopic nephroureterectomy. After 4-years of follow-up, the patient remained disease-free. By contrast, a right renal tumor was identified in the 74-year-old female patient during a routine examination. Radical right nephrectomy and lymph node dissection were performed, however, 10 months after surgery the patient succumbed due to wide-spread metastasis. The two cases reported in the present study not only represent excellent examples of the disease spectrum, but also act as a reminder of the possibility of detecting BDC in an early stage of disease. Therefore, the epidemiology of BDC has been discussed, and the aggressive growth pattern of BDC has been presented in terms of signs, symptoms and imaging examinations, including ultrasonography, computed tomography (CT), angiography and single photon emission CT, in the early stage of disease.

Collecting duct carcinoma of the kidney: A case report

Collecting duct carcinoma (CDC) is a rare type of renal tumor, arising from the distal collecting ducts. The prognosis of this disease is extremely poor due to its rapid progression with widespread metastases. The present study reported a case of CDC involving the right renal region of a 62-year-old female patient, presented with right-flank pain that had persisted for one month. A computed tomography scan demonstrated multiple hypoattenuating quasicircular lesions, 0.5-4.3 cm in size, in the upper pole of the right kidney. Following the diagnosis of a right renal tumor, laparoscopic radical resection of the right kidney was performed. Pathological examination demonstrated that the tumor cells were arranged in a glandular or papillary pattern, and marked cytological atypia was observed. Immunohistochemical staining revealed that the tumor cells were positive for epithelial membrane antigen and cytokeratin (CK)7, while they reacted focally with vimentin. However, the tumor cells were negative for CK20, CD10, uroplakin III and p63. Based on these findings, the patient was diagnosed with CDC. In conclusion, immunohistochemical analysis is critical in establishing an accurate diagnosis of CDC and distinguishing this tumor from other subtypes of RCC.

Clinical features and treatment of collecting duct carcinoma of the kidney from the korean cancer study group genitourinary and gynecology cancer committee

Purpose

Collecting duct carcinoma (CDC) of the kidney is an aggressive disease with a poor prognosis, accountings for less than 1% of all renal cancers. To date, no standard therapy for CDC has been established. The aim of this study is an investigation of clinicopathologic findings of CDC and correlation of the disease status with a prognosis.

Materials and Methods

From 1996 to 2009, 35 patients with CDC were treated at eight medical centers. The diagnosis of CDC was made based on nephrectomy in 27 cases and renal biopsy in eight cases.

Results

Median PFS and OS for all patients were 5.8 months (95% CI 3.5 to 9.2) and 54.4 months (95% CI 0 to 109.2), respectively. The OS of patients with Stages I-III was 69.9 months (95% CI 54.0 to 85.8), while that of patients with Stage IV was 8.6 months (95% CI 0 to 23.3), which showed a statistically significant difference (p=0.01). In addition, among patients with Stage IV, the OS of patients who received a palliative treatment (immunotherapy, chemotherapy, or targeted therapy) was 18.4 months, which was higher than the OS of patients without treatment of 4.5 months.

Conclusion

CDC is a highly aggressive form of renal cell carcinoma. Despite most of the treatments, PFS and OS were short, however, there were some long-term survivors, therefore, conduct of additional research on the predictive markers of the several clinical, pathological differences and their treatments will be necessary.

Collecting duct carcinoma of the kidney: Imaging observations of a rare tumor

Collecting duct carcinoma (CDC) is a rare type of renal neoplasm. Early diagnosis is possibly the only factor leading to a prolonged survival for patients with CDC. The purpose of the present study was to characterize the imaging features of CDC and improve its diagnosis. Radiological data of six patients were retrospectively reviewed by three experienced radiologists, including six cases examined with non-contrast computed tomography (CT) scans, five with contrast-enhanced CT scans, one with magnetic resonance urography, one with renal dynamic imaging and two with conventional whole-body ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scans. All patients were pathologically confirmed with CDC. In total, seven tumors were detected in the six cases, with a mean size of 5.3 cm. Of the tumors, two were solid and the rest were complex solid and cystic. In addition, six tumors were located in medullary areas and only one tumor was found in the cortical location. Cystic components were observed in five tumors. Weak enhancements were observed in all six tumors examined with contrast-enhanced CT, and heterogeneous enhancements were also observed in the majority of these tumors with the exception of one tumor. Infiltrative growth and expansible growth were found in five and two tumors, respectively. Metastatic lesions were detected in all six patients. On MR urography, the involved kidney exhibited similar imaging observations to the CT scan. Renal dynamic imaging revealed a decreased renal function in the involved kidney and an increased renal function in the contralateral kidney. On PET/CT imaging, a marked uptake of ¹⁸F-FDG was found in primary and metastatic lesions. The results of the present study indicated that medullary location, weak and heterogeneous enhancement, infiltrative growth, damage of renal function in the involved kidney and a marked uptake of ¹⁸F-FDG are imaging observations commonly identified in patients with CDC. When a renal tumor exhibits these imaging features, CDC may be suggested as a valuable differential diagnosis.

Arp2/3 complex inhibitors adversely affect actin cytoskeleton remodeling in the cultured murine kidney collecting duct M-1 cells

Dynamic remodeling of the actin cytoskeleton plays an essential role in cell migration and various signaling processes in living cells. One of the critical factors that controls the nucleation of new actin filaments in eukaryotic cells is the actin-related protein 2/3 (Arp2/3) complex. Recently, two novel classes of small molecules that bind to different sites on the Arp2/3 complex and inhibit its ability to nucleate F-actin have been discovered and described. The current study aims at investigating the effects of CK-0944666 (CK-666) and its analogs (CK-869 and inactive CK-689) on the reorganization of the actin microfilaments in the cortical collecting duct cell line, M-1. We show that treatment with CK-666 and CK869 results in the reorganization of F-actin and drastically affects cell motility rate. The concentrations of the compounds used in this study (100-200 μM) neither cause loss of cell viability nor influence cell shape or monolayer integrity; hence, the effects of described compounds were not due to structural side effects. Therefore, we conclude that the Arp2/3 complex plays an important role in cell motility and F-actin reorganization in M-1 cells. Furthermore, CK-666 and its analogs are useful tools for the investigation of the Arp2/3 complex.

Mixed collecting duct and renal cell carcinoma presenting with spinal cord compression

Collecting duct carcinoma (CDC) is a rare renal malignancy thought to develop from the collecting duct epithelium of the kidney. CDC tends to have a more aggressive clinical course than conventional renal cell carcinoma (RCC), with early metastases. The occurrence of a mixed CDC and conventional RCC is infrequently reported in the literature. We report the first case of a metastatic mixed CDC and RCC presenting as back pain in a young adult. In addition we discuss the epidemiology of and current adjuvant therapies for CDC.

Coexistence of Different Histotypes of Renal Carcinoma: Our Experience and Literature Review

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney.

Materials and Methods

We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies.

Results

Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect.

Conclusions

The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.

A renal cell carcinoma with components of both chromophobe and papillary carcinoma

We report a case of a morphologically unusual renal cell carcinoma with features of both chromophobe and papillary carcinoma. Immunohistochemical analysis of high molecular weight cytokeratins (HMWCK), cytokeratin 7 (CK7), cytokeratin 19 (CK19), c-Kit, and alpha-methylacyl-CoA racemase (AMACR) demonstrated differential profiles for the two components of the tumor, consistent with the respective patterns commonly observed for pure chromophobe and papillary renal cell carcinomas. Specifically, the chromophobe tumor cells expressed CK7 and c-Kit weakly, while HMWCK, CK19, and AMACR were not detectable. In contrast, the papillary tumor cells expressed uniformly HMWCK, CK7, and c-Kit and focally CK19 and AMACR. Fluorescence in situ hybridization analysis of nuclei isolated from paraffin-embedded tumor tissue detected monosomy 1, disomy 7, and monosomy 17, a common and characteristic finding in chromophobe carcinomas, in a majority of, but not all tumor cells, whereas a population characterized by disomy 1, trisomy 7, and trisomy 17, a frequent finding in papillary carcinoma, was not identifiable. Electron microscopic analysis revealed numerous characteristic small cytoplasmic vesicles in the chromophobe areas, which were absent in the papillary component. This case illustrates the rare coexistence of two distinct and admixed histologic types of renal cell carcinoma.

Collecting duct carcinoma of the kidney: CT and pathologic correlation

PURPOSE

We characterized CT findings of collecting duct carcinoma of the kidney and correlated these with the histopathologic findings.

MATERIALS AND METHODS

CT scans of 18 patients with pathologically proven collecting duct carcinoma of the kidney were retrospectively reviewed. We analyzed CT findings of collecting duct carcinoma and also correlated CT findings with the histopathologic findings.

RESULTS

The mean size of the tumors was 6.9 cm and all cases were solid. Seventeen (94%) tumors had a medullary location. Nine (69%) and 11 (85%) cases showed weak and heterogeneous enhancement, respectively. A cystic component (50%) was frequently seen within the tumors. Lymphadenopathy and metastasis were noted in 10 (56%) and 6 (33%) cases, respectively. Perinephric stranding and vascular invasion were present in 10 (56%) and 5 (28%) cases, respectively. In 17 (94%) of the 18 cases, involvement of the renal sinus was present. Infiltrative growth (67%) and preservation of the renal contour (61%) were more common than expansile growth (33%) and exophytic configuration (39%), respectively. These CT features were well correlated with the histopathologic findings.

CONCLUSION

Medullary location, weak and heterogeneous enhancement, involvement of the renal sinus, infiltrative growth, preserved renal contour, and a cystic component are CT findings frequently seen in patients with collecting duct carcinoma of the kidney. CT findings are nevertheless nonspecific and do not allow collecting duct carcinoma to be easily differentiated from the other subtypes of renal cell carcinoma. However, when CT demonstrates a renal tumor with these findings, collecting duct carcinoma can be considered in the differential diagnosis.

Composite distal nephron-derived renal cell carcinoma with chromophobe and collecting duct carcinomatous elements

Chromophobe renal cell carcinoma (RCC) and collecting duct carcinoma (CDC) are derived from the collecting duct epithelia, although their morphology, molecular biologic characteristics and clinical behaviors are quite different. Herein is presented a case of RCC possessing the chromophobe RCC and CDC elements occurring in a 64 year-old Japanese woman. The patient was referred to Yokohama City University Hospital with complaints of persistent back pain and fever. Radiologic examinations revealed a left renal tumor, and radical nephrectomy was performed. The patient died with multiple metastases, 8 months after the operation. The resected tumor showed an invasive growth, and its cut surface was heterogenous with hemorrhage and necrosis. Histologically, the tumor was composed of chromophobe elements with dedifferentiation, and CDC elements. The chromophobe and CDC elements had obvious histological transition. Lectin histochemistry and immunohistochemistry confirmed that this tumor was derived from the distal nephron. c-KIT, p53 and Ki67 antigen showed differential localization between the chromophobe and CDC elements, even in the transitional areas. Along with the previous reports, the present case seemed to be composite RCC derived from the collecting duct, which might present clues to elucidate carcinogenesis in the distal nephron.

Bellini duct carcinoma: review of diagnosis and management

AIM

To review the world literature on the histogenesis, diagnosis and management of Bellini duct carcinoma and to suggest a possible clinical algorithm to assist in their identification and appropriate therapeutic strategies.

METHODS

A medline review of all reported cases of Bellini duct carcinoma was carried out from the Pubmed using the keywords collecting duct carcinoma, Bellini duct carcinoma, medullary renal carcinoma and renal cancers.

RESULTS

40 worldwide reported cases of Bellini duct carcinoma were found. We analyzed their salient pathological, diagnostic and management strategies. A simplistic approach and a clinical algorithm has been suggested to enable their rapid identification, diagnosis and management.

Treatment outcome and survival associated with metastatic renal cell carcinoma of non-clear-cell histology

PURPOSE

To define outcome data for patients with metastatic renal cell carcinoma (RCC) with histology other than clear-cell type, including collecting duct (or medullary carcinoma), papillary, chromophobe, and unclassified histologies.

PATIENTS AND METHODS

Sixty-four patients with metastatic non-clear-cell RCC histology were the subjects of this retrospective review. Included in the analysis were 22 (8%) of 286 patients from a clinical trials database, 19 of 1,166 patients from a surgery database, and 23 of 357 patients from a pathology database.

RESULTS

The prevalent histology was collecting duct, present in 26 (41%) patients. The number of patients with chromophobe and papillary histologies was 12 (19%) and 18 (28%), respectively. Eight (12%) of the patients had tumors that could not be classified for specific tumor histology. Among the 43 patients treated with 86 systemic therapies, including 37 cytokine therapies, two patients (5%) were observed to have a partial response. The median overall survival time was 9.4 months (95% confidence interval, 8 to 14 months). The survival was longer for patients with chromophobe tumors compared with collecting duct or papillary histology, and this group included four patients with survival of greater than 3 years.

CONCLUSION

RCC consists of a heterogeneous group of tumors including clear-cell, papillary, chromophobe, collecting duct, and unclassified cell types. Non-clear-cell histologies constitute less than 10% of patients in general populations of patients with advanced RCC treated on clinical trials. Metastatic non-clear-cell RCC is characterized by a resistance to systemic therapy and poor survival, with the survival for patients with chromophobe tumors longer than that for patients with metastatic collecting duct or papillary RCC. Treatment with novel agents on clinical trials is warranted.