Collecting duct renal cell carcinoma

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  • Actas Urol Esp. 2011;35(6):368---371

    Actas Urolgicas Espaolas

    www.elsevier.es/actasuro

    CASUISTRY

    Collec

    A. Husillos , F. Herranz-Amo, D. Subir, E. Lled, R. Molina-Escudero,C. Hernndez-Fernndez

    Servicio de

    KEYWOKidney;Tumor;CollectinBellini

    PALABRRinn;Tumor;ConductcolectorBellini

    Please ci Correspo

    E-mail ad

    2173-5786/$Urologa, Hospital General Universitario Gregorio Marann, Madrid, Spain

    RDS

    g duct;

    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.

    AS CLAVE

    oses;

    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: adrhusillos@hotmail.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

    meenfe

    buloa te

    paa

    Introduc

    Collectingis the leastthree majocases havecharacteriznate outcocases or castudy is tothe analysparticular,

    Material

    We revisedJanuary 20ing duct resex, reasonof the affeteristics, ttreatment

    A descrMicrosoft Otive variabmedian witysis of quainferentialsample size

    Results

    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

    tion

    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-

    Figureing duc

    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

    progression(4.75---14.7

    Of the 4disseminatapy to surgtemsirolimchemotherNone of themetastasisthe metast

    Discussio

    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.

    n

    ing duct renal carcinoma is a rare entity that hasy presented an ominous oncologic prognosis. Our

  • 370 A. Husillos et al.

    Tabl

    e1

    Clin

    icop

    atho

    logi

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    esof

    patien

    tswith

    colle

    ctin

    gdu

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    ellc

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    nom

    a.

    Case

    Age

    Sex

    Size

    (max

    imum

    diam

    eter

    )TN

    MSu

    rgic

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    ent

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    tation

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    al(m

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    stat

    us

    177

    Man

    4.5cm

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    0Ra

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    lne

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    17m

    onth

    s---

    CR2

    72W

    oman

    3.5cm

    T1N0M

    2Ra

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    udy

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    rebe

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    met

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    ses

    Tem

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    omat

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    type

    Belli

    nias

    soci

    ated

    with

    clea

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    oma

    (Fuh

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    grad

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    4m

    onth

    s---

    DD

    368

    Man

    13cm

    T3bN

    2M1

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    hem

    atur

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    tin

    and

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    cita

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    lopa

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    ryBe

    llini

    8m

    onth

    s---

    DD

    486

    Man

    7cm

    T4N1M

    2Non

    eCo

    nstitu

    tion

    alsy

    ndro

    me

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    ePu

    reBe

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    2m

    onth

    s---

    DD

    579

    Man

    11.5

    cmT3

    bN2M

    1Ra

    dica

    lne

    phre

    ctom

    yMac

    rosc

    opic

    hem

    atur

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    llini

    7m

    onth

    s---

    DD

    669

    Man

    5cm

    T2N0M

    0Ra

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    120

    mon

    ths

    ---CR

    DD:di

    edof

    dise

    ase;

    CR:co

    mpl

    ete

    rem

    ission

    .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.

    References

    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.

    03;16Die

    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.

    208. De

    Henu

    9. OrReac20

    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

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