Collecting Duct Carcinoma of the Native Kidney in a Renal Transplant Recipient

Abstract

Collecting duct carcinoma (CDC) is a rare and aggressive form of renal cell carcinoma (RCC) arising from the epithelium of Bellini's duct. It presents earlier in life and has a poorer prognosis than the clear-cell type. Historically, immunosuppressed renal transplant patients are more likely to develop malignancies than the general population. We report a case of CDC of the native kidney in a 59-year-old man who initially underwent kidney transplantation five years before the time of presentation. To our knowledge, CDC in the setting of renal transplant and long-term immunosuppression has not been previously described.

Rarely Described Renal Malignancies Associated With Venous Tumor Thrombus

“…CDC generally affects patients in the 4 th to 7 th decade of live, with a male predominance of 2:1. Clinical symptoms ae often nonspecific, and include hematuria, flank pain, palpable abdominal mass and weight loss (2). CDC diagnosis is often based on histopathological findings as tumors may extend into the renal pelvis, mimicking pelvic urothelial carcinoma on imaging studies (15).…”

“…CDC diagnosis is often based on histopathological findings as tumors may extend into the renal pelvis, mimicking pelvic urothelial carcinoma on imaging studies (15). Typical CT findings include inner medullary location, renal sinus involvement and infiltrative growth that can reach the cortex (2). Microscopic features may be variable, however, the morphologic criteria for diagnosis include: presence of an infiltrative tubular or tubule-papillary pattern associated with a desmoplastic stromal reaction.…”

“…The most common type of RCC is clear cell, followed by papillary and chromophobe; which represent 85% of all RCC cases (1). The remaining 15% comprises rarer renal tumors such as collecting duct carcinoma (CDC); which accounts for only <1% of all renal cell carcinomas and is characterized by its aggressiveness, poor prognosis and lack of response to conventional therapies (2). CDC arises from the Bellini ducts epithelium, located in the distal collecting duct of the renal medulla, and was first reported by Foot and Papanicolaou in 1949.…”

Collecting Duct Carcinoma: A Rare Entity

“…Immunohistochemically, papillary renal cell carcinoma shows frequent positivity for CK7 and, occasionally, CD9 (Konjengbam& Singh, 2017). Renal medullary carcinoma commonly shows islands of anastomosing tubule, and cords forming irregular microcystic spaces and usually occur in young black patients with sickle cell trait, with a different history and age of patients, and the INI-1 retention is strictly able to rule out the possibility of medullary carcinoma (Konjengbam & Singh, 2017;Zheng et al, 2017;Gupta et al, 2012).…”

“…No 1 JANUARY 2020 et al, 2017) Most CDC tumor cells express PAX8, High Molecular Weight Cytokeratin, sometimes also CK7, and strongly positive for epithelial membrane antigen (EMA), focal reactive with vimentin, but they do not express CK20, CD117, CD10, GATA3 and p63 on immunohistochemistry staining (Hu et al, 2015;López et al, 2015;Zheng et al, 2017).…”