Case Report Urol Int 1992:48:460-462
Hiroshi Miyamotoa Osamn Kuwamitsua Masatoshi Moriyamaa Seizou Sakanishia Hiroshi Fujiia .S/uy/ Fukushimaa 7/« vî/ Sanoh Yoshiharu Oakic
Bellini Duct Carcinoma of the Kidney
Departments of Urology and Pathology, Yokohama Municipal Citizen’s Hospital and Department of Pathology, Yokohama City University, Japan
Keyw ords
Abstract
Renal carcinoma Duct of Bellini Lection Monoclonal antibody Immunohistochemical method
We report a very rare case of Bellini duct carcinoma originating from the col lecting tubules of the kidney. A left renal tumor was detected during a health examination and radical nephrectomy was performed. Histological examina tion showed papillary adenocarcinoma. By means of immunohistochemical methods, we felt that the tumor was a renal carcinoma of Bellini duct origin.
Most renal tumors of epithelial origin have been de scribed as renal cell carcinoma originating from the proxi mal tubules. However, several reports have described that tumor arose from the distal nephron. [1-6]. The following case was thought to originate from the collecting ducts of Bellini.
Case Report A 65-year-old man was admitted to our hospital because of a left renal mass detected during a health examination (fig. 1). Intravenous pyelography revealed downward displacement of the left renal pelvis by a renal mass. Digital subtraction angiography demonstrated a large tumor at the upper pole of the left kidney with partial neovascu larity in a hypovascular area (fig. 2).
Received: December 18. 1990 Accepted: May 27, 1991
Laboratory studies, including urinalysis, complete blood count and blood chemistry tests, showed normal values. Results of evalua tion for metastatic disease were negative. A left radical nephrectomy and para-aortic lymphadcncctomy were done through a transperitoneal incision. A tumor thrombus in the inferior vena cava was identified and thrombectomy was success fully performed. Histological examination of the tumor revealed adenocarcinoma that consisted of papillary strictures (fig. 3). The nuclei were large with distinct coarse nucleoli and the cytoplasms were eosinophilic. There were invasions of renal pelvis, ureter, and adrenal gland. Lymph node metastasis was shown. Microscopically the tumor seemed to arise from the lower neph ron, so we studied tissue tinction tests using three monoclonal anti bodies. The tumor cells showed a positive reaction for epithelial membrane antigen and cytokeratin; however, Tamm-Horsfall pro tein was negative (fig. 4). The immunohistochemical findings were consistent with a diagnosis of Bellini duct carcinoma. The patient has remained well for 7 months since the surgery without evidence of recurrence.
Dr. Hiroshi Miyamoto Department of Urology Yokohama Municipal Citizen's Hospital 56. Okazawa-cho. Hodogaya-ku. Yokohama 240 (Japan)
© 1992 S. Kargcr AG. Basel 0042-1138/92/0484-0460 $2.75/0
Downloaded by: Kings's College London 137.73.144.138 - 11/13/2017 11:10:32 PM
Introduction
t
Fig. 1. CT scan. Cystic tumor with low density area of the left
kidney. Fig. 2. Digital subtraction angiography. Hypovascular area with partial neovascularity in the left kidney.
2
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....
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i* r
Discussion
The first case of primary renal carcinoma of possible collecting duct origin was reported by Cromic ct al. [ 1] in 1979. and several cases of distal nephron carcinoma have been reported [2-6]. Most of these patients complained of gross hematuria or flank pain. In advanced cases chemo therapy and radiation therapy were performed after ne phrectomy, but the prognosis was poor.
y
"■ - • .
Fig. 4. Tumor cells showing positive reactions for EM A on the glandular surface.
In the past light- or electron-microscopic findings were used to distinguish Bellini duct carcinoma from other renal carcinomas. Recently histochemical and immuno histochemical methods have been developed. Reactions to lection and various antibodies have been able to iden tify the localization of renal tumors [7] (table 1). There fore, the characteristics of lower nephron carcinoma will be proved some more.
461
Downloaded by: Kings's College London 137.73.144.138 - 11/13/2017 11:10:32 PM
Fig. 3. Microscopic appearance. Papillary adenocarcinoma. HE.
X 200.
u i*
^
Table 1. Markers tested in normal
kidney SBA PNA DBA LTA THP EMA CK VM
GLM
BMC
PCT
PST
Thin
Thick
DCT
CCT
MCT
DBL
_
_
_
_
_
+
-
-
-
-
-
-
-
+
+ + +
+ +
-
+ +
-
+ + +
-
-
+
+
-
-
-
-
-
+ + + +
-
-
-
-
-
-
-
-
-
-
+ + -
+ + + -
-
-
+ + -
+ + +
+ + +
+ + -
+
-
-
-
GLM = Glomerulus; BMC = Bowman’s capsule; PCT = proximal tubule, convolution; PST = proximal tubule, straight; Thin = thin limb of Henle; Thick = thick ascending limb; DCT = distal convoluted tubule; CCT = cortical collecting tubule; MCT = medullary col lecting tubule; DBL = duct of Bellini. SBA = soybean agglutinin; PNA « peanut agglutinin; DBA = Dolichos biflorus agglutinin; LTA = Lotus tetragonolobus agglutinin; THP = TaminHorsfall protein; EMA = epithelial membrane antigen; CK = cytokeratin; VM = vimentin.
References
2
Cromie WJ, Davis CJ, De Ture FA: Atypical carcinoma of kidney. Possibly originating from collecting duct epithelium. Urology 1979; 13: 315-317. O'Brien PK, Bedard YC: A papillary' renal col lecting the renal pelvis in a young girl. A lightand electron-microscopic study. Am J Clin Pa thol 1980;73:427-433.
462
3
4
Hai MA, Diaz-Perez R Atypical carcinoma of kidney originating from collecting epithelium. Urology 1982;19:89-92. Norgaard T. Skaarup P: Infiltrating renal col lecting duct carcinoma with epithelial dyspla sia of the renal pelvis. Scand J Urol Nephrol 1985;19:69-70.
5
6
7
Miyamoto/Kuwamitsu/Moriyama/ Sakanishi/Fujii/Fukushima/Sano/Oaki
Lack EE. Cassady JR, Saltan ST: Renal ceil car cinoma in childhood and adolescence. A clini cal and pathological study of 17 cases. J Urol 1985;133:822-828. Becht E, Muller SC, Storkel S, Aiken P: Distal nephron carcinoma. A rare kidney tumor. Eur Urol 1988;14:253-254. Aizawa S, Kikuchi Y, Suzuki M. Furusato M: Renal cell carcinoma of lower nephron origin. Acta Pathol Jpn 1987;37:567-574.
Bellini Duct Carcinoma of the Kidney
Downloaded by: Kings's College London 137.73.144.138 - 11/13/2017 11:10:32 PM
1
Hiroshi Miyamotoa Osamn Kuwamitsua Masatoshi Moriyamaa Seizou Sakanishia Hiroshi Fujiia .S/uy/ Fukushimaa 7/« vî/ Sanoh Yoshiharu Oakic
Bellini Duct Carcinoma of the Kidney
Departments of Urology and Pathology, Yokohama Municipal Citizen’s Hospital and Department of Pathology, Yokohama City University, Japan
Keyw ords
Abstract
Renal carcinoma Duct of Bellini Lection Monoclonal antibody Immunohistochemical method
We report a very rare case of Bellini duct carcinoma originating from the col lecting tubules of the kidney. A left renal tumor was detected during a health examination and radical nephrectomy was performed. Histological examina tion showed papillary adenocarcinoma. By means of immunohistochemical methods, we felt that the tumor was a renal carcinoma of Bellini duct origin.
Most renal tumors of epithelial origin have been de scribed as renal cell carcinoma originating from the proxi mal tubules. However, several reports have described that tumor arose from the distal nephron. [1-6]. The following case was thought to originate from the collecting ducts of Bellini.
Case Report A 65-year-old man was admitted to our hospital because of a left renal mass detected during a health examination (fig. 1). Intravenous pyelography revealed downward displacement of the left renal pelvis by a renal mass. Digital subtraction angiography demonstrated a large tumor at the upper pole of the left kidney with partial neovascu larity in a hypovascular area (fig. 2).
Received: December 18. 1990 Accepted: May 27, 1991
Laboratory studies, including urinalysis, complete blood count and blood chemistry tests, showed normal values. Results of evalua tion for metastatic disease were negative. A left radical nephrectomy and para-aortic lymphadcncctomy were done through a transperitoneal incision. A tumor thrombus in the inferior vena cava was identified and thrombectomy was success fully performed. Histological examination of the tumor revealed adenocarcinoma that consisted of papillary strictures (fig. 3). The nuclei were large with distinct coarse nucleoli and the cytoplasms were eosinophilic. There were invasions of renal pelvis, ureter, and adrenal gland. Lymph node metastasis was shown. Microscopically the tumor seemed to arise from the lower neph ron, so we studied tissue tinction tests using three monoclonal anti bodies. The tumor cells showed a positive reaction for epithelial membrane antigen and cytokeratin; however, Tamm-Horsfall pro tein was negative (fig. 4). The immunohistochemical findings were consistent with a diagnosis of Bellini duct carcinoma. The patient has remained well for 7 months since the surgery without evidence of recurrence.
Dr. Hiroshi Miyamoto Department of Urology Yokohama Municipal Citizen's Hospital 56. Okazawa-cho. Hodogaya-ku. Yokohama 240 (Japan)
© 1992 S. Kargcr AG. Basel 0042-1138/92/0484-0460 $2.75/0
Downloaded by: Kings's College London 137.73.144.138 - 11/13/2017 11:10:32 PM
Introduction
t
Fig. 1. CT scan. Cystic tumor with low density area of the left
kidney. Fig. 2. Digital subtraction angiography. Hypovascular area with partial neovascularity in the left kidney.
2
X i
cv.it
—
•>V ,
....
*v
*gâL »
i* r
Discussion
The first case of primary renal carcinoma of possible collecting duct origin was reported by Cromic ct al. [ 1] in 1979. and several cases of distal nephron carcinoma have been reported [2-6]. Most of these patients complained of gross hematuria or flank pain. In advanced cases chemo therapy and radiation therapy were performed after ne phrectomy, but the prognosis was poor.
y
"■ - • .
Fig. 4. Tumor cells showing positive reactions for EM A on the glandular surface.
In the past light- or electron-microscopic findings were used to distinguish Bellini duct carcinoma from other renal carcinomas. Recently histochemical and immuno histochemical methods have been developed. Reactions to lection and various antibodies have been able to iden tify the localization of renal tumors [7] (table 1). There fore, the characteristics of lower nephron carcinoma will be proved some more.
461
Downloaded by: Kings's College London 137.73.144.138 - 11/13/2017 11:10:32 PM
Fig. 3. Microscopic appearance. Papillary adenocarcinoma. HE.
X 200.
u i*
^
Table 1. Markers tested in normal
kidney SBA PNA DBA LTA THP EMA CK VM
GLM
BMC
PCT
PST
Thin
Thick
DCT
CCT
MCT
DBL
_
_
_
_
_
+
-
-
-
-
-
-
-
+
+ + +
+ +
-
+ +
-
+ + +
-
-
+
+
-
-
-
-
-
+ + + +
-
-
-
-
-
-
-
-
-
-
+ + -
+ + + -
-
-
+ + -
+ + +
+ + +
+ + -
+
-
-
-
GLM = Glomerulus; BMC = Bowman’s capsule; PCT = proximal tubule, convolution; PST = proximal tubule, straight; Thin = thin limb of Henle; Thick = thick ascending limb; DCT = distal convoluted tubule; CCT = cortical collecting tubule; MCT = medullary col lecting tubule; DBL = duct of Bellini. SBA = soybean agglutinin; PNA « peanut agglutinin; DBA = Dolichos biflorus agglutinin; LTA = Lotus tetragonolobus agglutinin; THP = TaminHorsfall protein; EMA = epithelial membrane antigen; CK = cytokeratin; VM = vimentin.
References
2
Cromie WJ, Davis CJ, De Ture FA: Atypical carcinoma of kidney. Possibly originating from collecting duct epithelium. Urology 1979; 13: 315-317. O'Brien PK, Bedard YC: A papillary' renal col lecting the renal pelvis in a young girl. A lightand electron-microscopic study. Am J Clin Pa thol 1980;73:427-433.
462
3
4
Hai MA, Diaz-Perez R Atypical carcinoma of kidney originating from collecting epithelium. Urology 1982;19:89-92. Norgaard T. Skaarup P: Infiltrating renal col lecting duct carcinoma with epithelial dyspla sia of the renal pelvis. Scand J Urol Nephrol 1985;19:69-70.
5
6
7
Miyamoto/Kuwamitsu/Moriyama/ Sakanishi/Fujii/Fukushima/Sano/Oaki
Lack EE. Cassady JR, Saltan ST: Renal ceil car cinoma in childhood and adolescence. A clini cal and pathological study of 17 cases. J Urol 1985;133:822-828. Becht E, Muller SC, Storkel S, Aiken P: Distal nephron carcinoma. A rare kidney tumor. Eur Urol 1988;14:253-254. Aizawa S, Kikuchi Y, Suzuki M. Furusato M: Renal cell carcinoma of lower nephron origin. Acta Pathol Jpn 1987;37:567-574.
Bellini Duct Carcinoma of the Kidney
Downloaded by: Kings's College London 137.73.144.138 - 11/13/2017 11:10:32 PM
1
