Bellini's duct carcinoma: A report of two cases and a review of the literature

Abstract

Abstract. Bellini's duct carcinoma (BDC) is a rare and aggressive variant of renal cell carcinoma that possesses an extremely poor prognosis. The greater the grade or stage of disease, the poorer the prognosis tends to be. This study presents two cases of BDC; one case of low grade BDC and one case of high grade BDC in a 47-year-old male and 74-year-old female, respectively. The 47-year-old male patient presented with painless gross hematuria, which had lasted for 3 weeks and subsequently underwent purely laparoscopic nephroureterectomy. After 4-years of follow-up, the patient remained disease-free. By contrast, a right renal tumor was identified in the 74-year-old female patient during a routine examination. Radical right nephrectomy and lymph node dissection were performed, however, 10 months after surgery the patient succumbed due to wide-spread metastasis. The two cases reported in the present study not only represent excellent examples of the disease spectrum, but also act as a reminder of the possibility of detecting BDC in an early stage of disease. Therefore, the epidemiology of BDC has been discussed, and the aggressive growth pattern of BDC has been presented in terms of signs, symptoms and imaging examinations, including ultrasonography, computed tomography (CT), angiography and single photon emission CT, in the early stage of disease. IntroductionBellini's duct carcinoma (BDC), which arises from the distal segment of the collecting duct, is a rare and aggressive malignant tumor with a poor prognosis. BDC comprises <1% of all renal tumors (1), but it is extremely aggressive and is accompanied by metastatic diseases in the majority of reported cases. The prognosis of BDC is poor, with ~70% patients succumbing due to disease progression within 2 years of diagnosis (2). The only favorable prognosis factor is low-grade and low-stage disease (3-5). If BDC could be detected in the early stage of disease, the poor prognosis of BDC may be changed. However, due to the rarity of BDC, the similarities of the symptoms, signs and imaging examination findings with other variants of renal cell carcinoma (RCC), and the poor prognosis of BDC, it is challenging and crucial to differentiate other RCC variants from BDC. The RCC database of Peking University Shenzhen Hospital (Shenzen, China) was reviewed, and out of a total of 311 RCC cases, two cases of BDC with different grades of disease and prognoses were identified. Case reportCase one. In December 2010, a 47-year-old man presented to the Department of Urology, Peking University Shenzhen Hospital, with a complaint of painless gross hematuria during urination that had lasted 3 weeks. Physical examination revealed percussion pain over the left kidney region. The laboratory examinations revealed no extrarenal manifestations. The blood routine examination revealed no anemia and polycythemia; electrolyte examination revealed no hypercalcemia; erythrocyte sedimentation rate (ESR) examination revealed no fast ESR; and alkaline phosphatase examination revealed no elevated a...

Bellini Duct Carcinoma Misdiagnosed with Urothelial Papillary Carcinoma

“…Laboratory studies are usually normal, though microscopic hematuria and mild anemia were reported in some cases [2,5,6]. Alpha-fetoprotein (AFP), cancer embryonal antigen (CEA), and urine cytology might be positive [6] and, in some cases, such as ours, an important clue for a definite diagnosis.…”

“…In addition to the collecting duct mass, our patient showed multiple infracentimetric perihilar lymph nodes, hence considered a locally advanced disease. Heterogeneous masses, irregular borders, variable echoes, and blood flow signals were described on ultrasonography [2,6]. MRI reveals an isointense image on T1, iso-or hypointense image on T2, and lower enhancement compared to the normal cortex and medulla [4].…”

“…Collecting duct carcinoma (CDC) is a rare subtype of kidney tumors, accounting for less than 3% and known to have the worst prognosis with its tendency to early metastasis [1]. CDC is also called Bellini duct carcinoma (BDC) because it concerns the distal medullar segment of the collecting duct of Bellini [2]. Commonly, the disease is diagnosed between ages 40 and 71, with a 2 : 1 male to female ratio [1].…”

Carcinoma de los ductos colectores de Bellini: Presentación de un caso clínico y revisión del diagnóstico diferencial

“…Los factores que determinan un mejor pronóstico de estos tumores son el bajo grado y un menor estadio tumoral [14][15][16] . Existen pocos casos de este tumor con crecimiento exofítico y afectación linfática 6,8,9,17 y escasos estudios que describan el diagnóstico radiológico y su diagnóstico diferencial.…”

“…el túbulo contorneado proximal 6 . Mancilla-Jiménez et al 7 en 1976 describieron por primera vez la existencia de algunos carcinomas papilares que provenían de los túbulos colectores.…”