Pinto JA, Romero S, Lista MT, Díaz MV, Tirado M, Daboin HI

Language: Spanish
References: 29
Page: 221-229
PDF size: 606.63 Kb.

ABSTRACT

Background: Ductal cell carcinoma is an uncommon subtype of aggressive renal neoplasia arising from the medullary collecting ducts, which have been described in different countries and ethnic groups. Very few series of this tumor have been reported, and most publications in the medical literature deal with single cases.
Patients and method: We present the clinicopathological findings of 10 cases collected during the last decade. The patients were 6 males and 4 females that ranged in age from 34 to 65 years (mean: 51.3 years). Hematuria, hidronephrosis, lumbar pain, renal lithiasis and weight loss were the main clinical symptoms related to the renal tumors. Four patients died due to the neoplasia, and in three of them widespread metastases were found in the postmortem examination.
Results: Histologically, all the tumors showed a high Fuhrman nuclear-grade and were composed of a varied pattern of tubular, tubulopapillary, microcystic and trabecular epithelial cells growing in a desmoplastic stroma with mixed inflammation. Additionally in three tumors, we observed secretory metaplasia with signet ring cells, sarcomatoid changes and hyaline globules respectively. The tumor cells exhibited typical and consistent immunohistochemical positive staining with antibodies for cytokeratin 7, cytokeratin AE1/AE3 and Ulex europaeus lectin.
Conclusions: Histopathological features together with the immunohistochemical staining for cytokeratin 7 and Ulex europaeus are in our view, the most important findings for the identification of renal ductal carcinoma that is an entity not yet well recognized by some clinicians and pathologists.

REFERENCES

1. Amin MB, Varma MD, Tickoo SK, Ro JY, Collecting duct carcinoma of the kidney. Adv Anat Pathol 1997;4:85-94.

2. Kovacs G. Molecular differential pathology of renal cell tumours. Histopathology 1993;22:1-8.

3. Eble JN. Neoplasms of the kidney. In: Bostwick DB, Eble JN, editors. Urologic surgical pathology. 1st ed. St. Louis: Mosby, 1997;p:83-147.

4. Fleming S, Lewi HJE. Collecting duct carcinoma of the kidney. Histopathology 1986;10:1131-1141.

5. Srigley JR, Eble JN. Collecting duct carcinoma of kidney. Semin Diagn Pathol 1998;15:54-67.

6. Rumpelt HJ, Störkel S, Moll R, Schärfe T, Thoenes W. Bellini duct carcinoma: further evidence for this rare variant of renal cell carcinoma. Histopathology 1991;18:115-122.

7. Störkel S, Steart PV, Drenckhahn D, Thoenes W. The human chromophobe cell renal carcinoma: its probable relation to intercalated cells of the collecting duct. Virchows Arch B Cell Pathol Incl Mol Pathol 1989;56(4):237-245.

8. Matz LR, Lasham BI, Fabian VA, Vivian JB. Collecting duct carcinoma of the kidney: a report of three cases and review of the literature. Pathology 1997;29:354-359.

9. Skinnider BF, Folpe AL, Hennigar RA, Lim SD, et al. Distribution of cytokeratins and vimentin adult renal neoplasms and normal tissue. Potential utility a cytokeratins antibodies panel in the differential diagnosis of the renal tumors. Am J Surg Pathol 2005;29:747-754.

10. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982;6:655-663.

11. Weiss LM, Gelb AB, Medeiros LJ. Adult renal epithelial neoplasms. Am J Clin Pathol1995;103:624-635.

12. Kawanishi H, Aoyama T, Yoshida T, Sasaki M, Itoh T. Bellini duct carcinoma of the kidney: a case report. Hinyokika Kiyo 2000;46:401-404.

13. Prati GF, Dean P, Firpo M, Moscatelli P, et al. Bellini duct (collecting duct) carcinoma of the kidney. Int Urol Nephrol 1998;30:677-680.

14. Kennedy SM, Merino MJ, Linehan WM, Roberts JR, et al. Collecting duct carcinoma of the kidney. Hum Pathol 1990;21:449-456.

15. Pinto JA, Menolascino F, Daboin I, Romero K, Hernández S. Ductal cell carcinoma of the kidney with the extensive signet ring cell mucosecreting areas. A case report with immunohistochemical analysis. Pathol Res Pract 2001;197:827-832.

16. Baer SC, Ro JY, Ordoñez NG. Sarcomatoid collecting duct carcinoma. A clinicopatologic and immunohistochemical study of five cases. Hum Pathol 1993;24:1017-1022.

17. Gatalica Z, Uriettinew M, Kovatich A, Mc Cue PA. Hyaline globules in renal cell carcinomas and oncocytomas. Hum Pathol 1997;28:400-403.

18. Papadimitriou JC, Drachenberg CB, Brenner DS, Newkirk C, et al. “Thanatosomes”: a unifying morphogenetic concept for tumor hyaline globules related to apoptosis. Hum Pathol 2000;31:1455-1465.

19. De Diego Rodríguez E, Hernández Rodríguez R, Martín García B, Portillo Martín JA, et al. Masa retroperitoneal secundaria a carcinoma de Bellini. Actas Urol Esp 1999;23:801-805.

20. Mourad WA, Nestok BR, Saleh GY, Solez K, et al. Dysplastic tubular epithelium in “normal” kidney associated with renal cell carcinoma. Am J Surg Pathol 1994;18:1117-1124.

21. Han AC, Duszak R Jr. Coexpression of cytokeratins 7 and 20 confirms urothelial carcinoma presenting as an intrarenal tumor. Cancer 1999;86:2327-2330.

22. Mazal PR, Stichenwirth M, Koller A, Blach S, et al. Expression of aquaporins and PAX-2 compared to CD10 and cytokeratin 7 in renal neoplasms: a tissue microarray study. Mod Pathol 2005;18:535-540.

23. Delahunt B, Eble JN. Papillary renal cell carcinoma: a clinicopathologic and immunohistochemical study of 105 tumors. Mod Pathol 1997;10:537-544.

24. Srigley JR, Eble JN, Grignon DJ, Hartwick RWJ. Unusual renal cell carcinoma (RCC) with prominent spindle cell change possibly related to the loop of Henle. Mod Pathol 1999;12:107A.

25. Davis CJ, Mostofi FK, Sesterhen IA. Renal medullary carcinoma. The seventh sickle cell nephropathy. Am J Surg Pathol 1995;19:1-11.

26. Mc Lennan GT, Farrose GM, Bostwick DG. Low grade collecting duct carcinoma of the kidney: report of 13 cases of low grade mucinous tubulocyst renal carcinoma of possible collecting duct origin. Urology 1997;50:679-684.

27. Otani M, Shimizu T, Serizawa H, Ebihara Y, Nagashima Y. Low-grade renal cell carcinoma arising from the lower nephron: a case report with immunohistochemical, histochemical and ultrastructural studies. Pathol Int 2001;51:954-960.

28. Eble JN. Mucinous tubular and spindle cell carcinoma and post neuroblastoma carcinoma: newly recognized entities in the renal cell carcinoma family. Pathology 2003;35:499-504.

29. Parwani AV, Husain An, Epstein JI, Beckwith JB, Argani P. Lowgrade myxoid renal epithelial neoplasms with distal nephron differentiation. Hum Pathol 2001;32:506-512.