Actas Urol Esp. 2011;35(6):368---371
Actas Urolgicas Espaolas
A. Husillos , F. Herranz-Amo, D. Subir, E. Lled, R. Molina-Escudero,C. Hernndez-Fernndez
Please ci Correspo
2173-5786/$Urologa, Hospital General Universitario Gregorio Marann, Madrid, Spain
AbstractIntroduction: Bellinis renal cell collecting duct carcinoma is a rarely prevalent renal tumor,with low cancer-specic survival, although its rate of response to antiangiogenic therapies isunknown.Objectives: We retrospectively revise a series of collecting duct tumors, with special emphasison the indication of target therapies and on their results.Materials and methods: Retrospective analysis of renal cell collecting duct carcinoma treatedat our institution from January 2000 to June 2010, taking into account the patients age, sex,reason for the consultation, oncological background, side of the affection, surgical treatment,other anatomopathological characteristics, tumor size, TNM clinical staging (2009), adjuvanttreatment and survival time.Results: Six patients are described, ve men and one woman, with a mean age of 75 (7.7)years. Four of them (66.6%) presented disseminated disease upon diagnosis. Five (83%) weretreated with radical nephrectomy and three (50%) received systemic adjuvant treatment, with-out response. The means survival was 5.5 months (4.75---14.75). Only 2 patients (33.3%), bothwith localized disease upon diagnosis, are in complete remission.Conclusion: Renal cell collecting duct carcinoma is a disease with a bad prognosis, little survivaland bad response to target therapies. 2011 AEU. Published by Elsevier Espaa, S.L. All rights reserved.
Carcinoma de clulas renales del tbulo colector
ResumenIntroduccin: El carcinoma renal de los conductos colectores de Bellini es un tumor renalescasamente prevalente, con baja supervivencia cncer-especca, aunque realmente sedesconoce su tasa de respuesta a terapias antiangiognicas.Objetivos: Se revisa de manera retrospectiva una serie de tumores de tbulo colector conespecial nfasis en la indicacin de terapias diana y en los resultados de la misma.
te this article as: Husillos A, et al. Carcinoma de clulas renales del tbulo colecto. Actas Urol Esp. 2011;35:368---71.nding author.dress: email@example.com (A. Husillos).
see front matter 2011 AEU. Published by Elsevier Espaa, S.L. All rights reserved.ting duct renal cell carcinoma
Collecting duct renal cell carcinoma 369
Material y mtodos: Anlisis retrospectivo del carcinoma renal de tbulo colector tratados ennuestra institucin desde enero 2000 a junio 2010, teniendo en cuenta la edad del paciente, elsexo, el motivo de consulta, los antecedentes oncolgicos, el lado de afectacin, el tratamientoquirrgico, otras caractersticas anatomopatolgicas, el tamano tumoral, la estadicacin TNM(2009), el tratamiento adyuvante y el tiempo de supervivencia.
, 5%) pe nef
Collectingis the leastthree majocases havecharacteriznate outcocases or castudy is tothe analysparticular,
We revisedJanuary 20ing duct resex, reasonof the affeteristics, ttreatment
A descrMicrosoft Otive variabmedian witysis of quainferentialsample size
Of a total orenal celltics of thesThe male:fmeasuredpiece for taxial tomofor the repatients (8
1 CT radiological imaging of locally advanced collect-t renal carcinoma.
tient (16.6%) diagnosis was made by percutaneousFour of the 6 cases (66.6%) had lymphatic and/or
ogenous dissemination at diagnosis. Only two (33.3%)ted localized disease, which are those that are freerrence and alive today, with a follow-up of 120 andnths, respectively. The remaining patients died ofResultados: Se describen 6 pacientes75 ( 7,7) anos. Cuatro de ellos (66,6Cinco (83,3%) fueron tratados mediantsistmico adyuvante, sin respuesta. LaSlo dos pacientes (33,3%), ambos conremisin completa.Conclusin: El carcinoma renal de tescasa supervivencia y mala respuesta 2011 AEU. Publicado por Elsevier Es
duct renal carcinoma, also called Bellinis tumor,prevalent subtype of renal carcinoma. Except forr series published in recent years,1---3 only isolatedbeen reported. The collecting duct carcinoma ised by being an aggressive entity with an unfortu-me in most patients. In our country, only isolatedse series have been published. The aim of thisevaluate our own case series, with emphasis onis of the response to systemic therapy and, into new target therapies.
s and methods
all renal tumors diagnosed in our center from00 to June 2010, and identied cases of collect-nal carcinoma. The variables analyzed were: age,
for consultation, oncological background, sidection, surgical treatment, pathological charac-umor size, TNM staging (rating 2009), adjuvantand survival time.iptive statistical analysis was performed usingfce Excel 2003. For the analysis of quantita-
les the mean with the standard deviation and theh the interquartile range were used. In the anal-
one pabiopsy.hematpresenof recu17 molitative variables, we used the percentage. Anstatistical analysis was not performed due to low.
f 670 renal tumors, 6 (0.89%) were collecting ductcarcinoma. Table 1 summarizes the characteris-e patients. The mean age was 75 (7.71) years.emale ratio was 5:1. The average size of tumor,as the maximum diameter of the macroscopicumors that were operated, or with computerizedgraphy (CT)/nuclear magnetic resonance (NMR)st, was 65.5mm (39.6) (Figs. 1 and 2). Five3%) were treated with radical nephrectomy. In
Of the 4disseminatapy to surgtemsirolimchemotherNone of themetastasisthe metast
The collecttraditionallvarones y una mujer; con una media de edad deresentaban enfermedad diseminada al diagnstico.rectoma radical y tres (50%) recibieron tratamientodiana de supervivencia fue 5,5 meses (4,75-14,75).rmedad localizada al diagnstico, se encuentran en
colector es una enfermedad con mal pronstico,rapias diana., S.L. Todos los derechos reservados.of their disease, with a median survival of 5.55) months.patients with lymphatic and/or hematogenous
ion, three (75%) received adjuvant systemic ther-ery. Two received immunotherapy (sunitinib andus) and a third patient received a conventionalapy scheme based on cisplatin and gemcitabine.m presented remission of the adenopathy and/orin the follow-up performed with CT. Surgery onasis was not carried out either.
ing duct renal carcinoma is a rare entity that hasy presented an ominous oncologic prognosis. Our
370 A. Husillos et al.
.Figure 2 NMR radiological imaging of localized collectingduct renal carcinoma.
experiencelimited, buclinical res
This typtubules ofand distincradiologicapoint of vtures thatmedullarydesmoplasiImmunohishigh molecFez1, muci
There aber of caseThe age atfth decadpatients. Tseries, butpatients h
Figure 3carcinoma.with target therapies and chemotherapy is veryt it also conrms its ominous prognosis withoutponse.e of renal tumor develops from the collectingthe renal medulla, thus, presenting an unusualtive histology (Fig. 3). There are no specicl features of this tumor.4 From the pathologicaliew, there are a number of microscopic fea-point towards its diagnosis: commitment of thepyramids, irregular tubular architecture, markeda and the presence of high degree tack cells.tochemistry is usually positive for Ulex europeus,ular weight cytokeratin (CK19, CK7, CK8/18)n, lysozyme and lectins/peanut aglutinina.5,6
re three series published with a signicant num-s.1---3 They all observed a predominance of males.diagnosis of this neoplasm is usually from the
e of life, although there are also cases in younghe mean size at diagnosis varies depending on theit ranges between 6 and 8 cm. At diagnosis most
ave locally advanced disease with lymph node
Microscopic appearance of the collecting duct renal
Collecting duct renal cell carcinoma 371
and/or metastatic disease. All these data are consistent withour cases, although the age at diagnosis we observed tendsto be higher.
The treatment that was performed in most patientsdescribed above was radical nephrectomy, even in thosewith disseminated disease. However, the benet of cytore-ductive nephrectomy has not been objectied in patientswith metastatic collecting duct renal carcinoma either.7
Survival described long term is low and is around 0---58%at three years.1,8 In our experience, only patients withlocalized disease at diagnosis, lack of lymph node orhematogenous disease are free of recurrence. Two stud-ies compared cancer-specic survival of this neoplasm withclear cell renal carcinoma. In the series of Karakiewitz et al.no differences in survival are found if adjusted for stage.2
Nevertheless, this nding may be due to a low number ofcases (47 patients) and the inclusion of slants in choosingthe comparison cohort because it includes cases treated inthe 80s. In the series of Wright et al. a comparison betweencases diagnosed in the same period is performed, all from2000, nding statistically signicant difference in survival infavor of conventional renal cell carcinoma.1
None of the large series evaluates the response toadjuvant treatments with chemotherapy, immunotherapyor antiangiogenic therapy. From a pathological point ofview, there is some histopathogenetic proximity betweencollecting duct carcinoma and carcinoma of the upperurothelium. That is why, some authors have proposedtherapeutidoxorubiciour series,a good ressunitinib o
In summrenal tumoinated or llong-termtive treatmpatients w
Conict of interest
The authors declare that they have no conict of interest.
1. Wright JL, Risk MC, Hotaling J, Lin DW. Effect of collect-ing duct histology on renal cell cancer outcome. J Urol.2009;182:2595---600.
2. Karakiewicz PI, Trinh QD, Rioux-Leclercq N, de la Traille A,Novara G, Tostain J, et al. Collecting duct renal cell carcinoma:a matched analysis of 41 cases. Eur Urol. 2007;52:1140---6.
3. Tokuda N, Naito S, Matsuzaki O, Nagashima Y, Ozono S, IgarashiT. Collecting duct (Bellini duct) renal cell carcinoma: a nation-wide survey in Japan. J Urol. 2006;176:40---3.
4. Yoon SK, Nam KJ, Rha SH, Kim JK, Cho KS, Kim B, et al.Collecting duct carcinoma of the kidney: CT and pathologiccorrelation. Eur J Radiol. 2006;57:453---60.
5. Kobayashi N, Matsuzaki O, Shirai S, Aoki I, Yao M, NagashimaY. Collecting duct carcinoma of the kidney: an inmunohisto-chemical evaluation of the use of antibodies for differencialdiagnosis. Hum Pathol. 2008;39:1350.
6. Garca-Fadrique G, Ramrez-Backaus M, Morales G, PontonesJL, Jimnez Cruz JF. Carcinoma de los conductos colectoresde Bellini. Presentacin de un caso y revisin de la literatura.Actas Urol Esp. 2010;34:639---41.
7. Mejean A, Roupert M, Larousserie F, Hopirtean V, Thiounn N,Dufour B. Is there a place for radical nephrectomy in the pres-ences of metastatic collecting duct (Bellini) carcinoma? J Urol.
rnnestrasola Anal cterist05;65lowsk. Actney:02;94c regimens based on carboplatin-gemcitabine,n, gemcitabine and paclitaxel-carboplatin.9,10 Inpatients treated systemically have not shown
ponse to adjuvant treatment with temsirolimus,r cisplatin and gemcitabine.ary, collecting duct renal cell carcinoma is a rarer. In our series, most patients are in a dissem-ocally advanced stage at diagnosis. The rate ofsurvival is low because the only potentially cura-ent appears to be surgery if it is considered in
ith localized tumors.
10. MiDMkid209:1287---90.go RE, Pascual SC, Gutirrez Banos JL, Martn GB,dez RR, Portillo Martn JA, et al. Carcinoma de Bellini:experiencia. Arch Esp Urol. 2000;53:611., Tras A, Ravents CX, Espanol L, Cecchini L, Orsola I.
ollecting (Bellini) duct carcinoma displays similar char-ics to upper tract urothelial cell carcinoma. Urology.:49---54.y MI, Rosmarin A, Tickoo SK, Papanicolau N, Nanusive chemotherapy for collecting duct carcinoma of thea case report and review of the literature. Cancer.:111---6.
Collecting duct renal cell carcinomaIntroductionMaterials and methodsResultsDiscussionConflict of interestReferences