Original contributionCollecting duct carcinoma of the kidney: an immunohistochemical evaluation of the use of antibodies for differential diagnosis☆
Introduction
Renal epithelial neoplasms are composed of heterogeneous histologic subtypes, although clear cell renal cell carcinoma (RCC) accounts for approximately 80% of these cancers. Clear cell RCC comprises alveolar tumor cell architecture with a glycogen-rich clear cytoplasm and is associated also with sinusoid-like vasculature. Clear cell RCC has further been shown to harbor alterations in the von Hippel-Lindau tumor suppressor gene [1].
Papillary RCC accounts for approximately 10% of RCCs and is predominantly composed of papillary architecture lined with chromophilic tumor cells with fibrovascular cores. Papillary RCCs can be further classified into type 1 and type 2 tumors [2], and some harbor mutations in the c-met or fumarase genes. In addition, these lesions are often associated with familial occurrence, known as familial papillary RCC, and RCC-leiomyomatosis syndrome (for review, see Ref. [3]).
Chromophobe RCC and oncocytoma are derived from the intercalated cells of the collecting duct. The former is a low-grade malignancy, in spite of occasional sarcomatoid progression, whereas the latter is a benign tumor. These 2 lesions share various histologic and molecular biologic characteristics, and a differential diagnosis between them is therefore often challenging (for review, see Ref. [4]).
In addition to these subtypes, collecting duct carcinoma (CDC) has also been reported as a rare but aggressive subtype of renal epithelial neoplasm that is derived from the collecting duct. Although most cases of RCC can be successfully treated by surgical resection, CDC cases present with an unfavorable prognosis and often show postoperative recurrence and distant metastases [5]. In addition, the diagnostic criteria of CDC have not yet been fully established, which occasionally causes interobserver diagnostic discrepancies. Consequently, CDC is frequently difficult to distinguish from pelvic urothelial carcinoma with marked renal parenchymal invasion (invasive urothelial carcinoma [iUC]) and high-grade papillary RCC [6], although the World Health Organization recommends the use of the diagnostic criteria established by Srigley and Eble [7]. There are also several previous reports on the use of immunohistochemical markers for the differential diagnosis of these renal tumors, but some of these are not broadly used or commercially available yet [6]. In our present study, we examined the use of adopting such markers for the differential diagnosis of 17 cases of CDC, 10 iUCs, and 15 papillary RCCs.
Section snippets
Renal epithelial cancer cases examined in this study
The renal epithelial neoplasm cases included in our present analyses were obtained from the consultation files of 2 of the authors of this study (O.M. and Y.N.) and dated from 1980 to 2000. To make a diagnosis of CDC, we adopted the criteria proposed by Srigley and Eble [7], except for reactivity with Ulex europaeus agglutinin 1 (UEA-1) and positivity for high-molecular-weight cytokeratin (HMW-CK), as we wished to reevaluate the efficacy of these markers. Only cases with a concordant diagnosis
Renal epithelial cancer cases examined
Two of the pathologists who authored this study (O.M. and Y.N.) had previously diagnosed 17 cases of CDC, 10 cases of iUC, and 15 cases of papillary RCC (type 1, 6 cases; type 2, 9 cases), for which the clinicopathologic characteristics are shown in Table 2. In 1 CDC case, no clinical information was available. The CDC patients' ages ranged from 46 to 76 years (mean, 60.4 years) and included 11 men and 5 women. The pathologic stages were classified as follows: stage 1 (n = 1), stage 2 (n = 1),
Discussion
CDC is a renal epithelial malignancy derived from the collecting duct epithelia. Its incidence among all of the adult renal epithelial neoplasms that arise, however, is less than 1%. In addition, CDC generally occurs more commonly in the younger generation than in those of clear cell RCC and does not show any gender preference. The initial presentation of this tumor can often be generalized inflammatory symptoms, that is, fever or general malaise, as well as the classical triad associated with
Acknowledgments
We thank Drs Sumio Noguchi and Hideyuki Terao, Ms Michiko Ehara, Ms Tamiyo Taniguchi, Ms. Hiromi Soeda, and Ms. Yuko Sugiyama for their discussion, technical, and secretarial assistance.
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Cited by (68)
“Collecting duct carcinoma of the kidney: diagnosis and implications for management”
2022, Urologic Oncology: Seminars and Original InvestigationsTumors masquerading as type 2 papillary renal cell carcinoma: pathologists’ ever-expanding differential diagnosis for a heterogeneous group of entities
2022, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :CDC often has a prominent inflammatory infiltrate (Fig. 2C), which may be helpful. An especially infiltrative interface between tumor and the surrounding renal parenchyma with a desmoplastic stromal reaction also support a diagnosis of CDC [100-102], though these findings may understandably be difficult or impossible to appreciate on limited samples such as biopsies. CDC are highly aggressive tumors; in a series of cases of CDC, 75.6% were stage pT3 or above at diagnosis compared to 38% of CCRCC [103].
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2015, Pathology Research and PracticeCitation Excerpt :These cancer cells are highly atypical, showing pleomorphism, hyperchromatism and mitosis, with “hobnail” or “signet ring”-shaped cells. From the histological point of view, we should distinguish between papillary renal cell carcinoma and high-grade urothelial carcinoma [49,50]. Immunohistochemically, collecting duct carcinoma is typically positive for EMA and high molecular weight cytokeratins, and sometimes also for cytokeratin 7, while it is negative for CD10, CD117 and cytokeratin 20.
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This work was supported by the grants-in-aid from the Japanese Ministry of Science, Culture, Sports and Education and from Yokohama City University, Yokohama, Japan (to Y.N.).