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a. Plain abdominal X-ray.
Source publication
Bellini duct carcinoma is a rare type of renal tumor characterized by high malignancy. Race or gender-related differences in its incidence have not been demonstrated. There are, however, reports of a more frequent incidence in dialyzed patients as well as in those with renal failure and nephrolithiasis. The disease is usually diagnosed at a late st...
Citations
... Till 2013, almost 200 cases have been reported in the literature [5] with less than 5 cases reported later [1,5]. An increased prevalence of BDC was reported in patients with renal failure and nephrolithiasis and on hemodialysis [6], aligning well with our patient's history of recurrent urinary stones. ...
... This fact should always be kept in mind since it contributed to our initial misdiagnosis; our patient mostly presented nonspecific symptoms. The rest may be atypical (acute renal failure, metastatic lesions to bones or meninges, and lymphadenopathy) [5][6][7]. Common metastasis sites include the lungs, bones (as osteoblastic lesions), liver, and adrenal glands [3,6]. Metastasis or paraneoplastic symptoms are present in 40% of cases at presentation [1]. ...
... The rest may be atypical (acute renal failure, metastatic lesions to bones or meninges, and lymphadenopathy) [5][6][7]. Common metastasis sites include the lungs, bones (as osteoblastic lesions), liver, and adrenal glands [3,6]. Metastasis or paraneoplastic symptoms are present in 40% of cases at presentation [1]. ...
Background:
Collecting (Bellini) duct carcinoma (CDC) or Bellini duct carcinoma (BDC) is a rare subtype of kidney tumors, accounting for less than 3% and known to have the worst prognosis. It is known to have multiple clinical presentations; this is why it can be easily misdiagnosed. The aim of this article is to present a case of CDC that was initially misdiagnosed with urothelial papillary carcinoma (UPC) in a 41-year-old male. Case Presentation. Our patient presented with a left flank pain evolving for one month and one episode of gross macroscopic hematuria. Upon presentation, he had left costovertebral angle tenderness. Initial lab tests were normal. Computed tomography revealed a 5 cm solid mass of the left renal pelvis and multiple infracentimetric perihilar lymph nodes. Subsequently, the patient had left nephroureterectomy. Microscopic examination showed the presence of a high-grade urothelial papillary carcinoma of the renal pelvis' lumen. All four of the dissected lymph nodes showed disease metastasis. Three years after establishing the diagnosis, the patient presented again for chronic abdominal pain, with a recent history of weight loss. CT scan showed a left paraaortic mass infiltrating the left psoas muscle over a length of 12 cm. Immunohistochemical profiling of this mass confirmed the diagnosis of Bellini duct carcinoma, rejecting the initial diagnosis of UPC. Therefore, the patient required a cisplatin-gemcitabine-based chemotherapy regimen.
Conclusion:
BDC remains one of the rare aggressive subtypes of RCC, having a multitude of initial clinical presentations and an unfavorable prognosis. In this patient, CDC was masquerading as a transitional cell carcinoma that should always be kept in mind as a possible presentation. Corresponding early imaging and histopathology exams are primordial for a correct diagnosis and thus a better prognosis.
... Till 2013, almost 200 cases have been reported in the literature [5] with less than 5 cases reported later [1,5]. An increased prevalence of BDC was reported in patients with renal failure and nephrolithiasis and on hemodialysis [6], aligning well with our patient's history of recurrent urinary stones. ...
... This fact should always be kept in mind since it contributed to our initial misdiagnosis; our patient mostly presented nonspecific symptoms. The rest may be atypical (acute renal failure, metastatic lesions to bones or meninges, and lymphadenopathy) [5][6][7]. Common metastasis sites include the lungs, bones (as osteoblastic lesions), liver, and adrenal glands [3,6]. Metastasis or paraneoplastic symptoms are present in 40% of cases at presentation [1]. ...
... The rest may be atypical (acute renal failure, metastatic lesions to bones or meninges, and lymphadenopathy) [5][6][7]. Common metastasis sites include the lungs, bones (as osteoblastic lesions), liver, and adrenal glands [3,6]. Metastasis or paraneoplastic symptoms are present in 40% of cases at presentation [1]. ...
Collecting (Bellini) duct carcinoma (CDC) or Bellini duct carcinoma (BDC) is a rare subtype of kidney tumors, accounting for less than 3% and known to have the worst prognosis. It is known to have multiple clinical presentations; this is why it can be easily misdiagnosed. The aim of this article is to present a case of CDC that was initially misdiagnosed with urothelial papillary carcinoma (UPC) in a 41-year-old male. Case Presentation. Our patient presented with a left flank pain evolving for one month and one episode of gross macroscopic hematuria. Upon presentation, he had left costovertebral angle tenderness. Initial lab tests were normal. Computed tomography revealed a 5 cm solid mass of the left renal pelvis and multiple infracentimetric perihilar lymph nodes. Subsequently, the patient had left nephroureterectomy. Microscopic examination showed the presence of a high-grade urothelial papillary carcinoma of the renal pelvis’ lumen. All four of the dissected lymph nodes showed disease metastasis. Three years after establishing the diagnosis, the patient presented again for chronic abdominal pain, with a recent history of weight loss. CT scan showed a left paraaortic mass infiltrating the left psoas muscle over a length of 12 cm. Immunohistochemical profiling of this mass confirmed the diagnosis of Bellini duct carcinoma, rejecting the initial diagnosis of UPC. Therefore, the patient required a cisplatin-gemcitabine-based chemotherapy regimen. Conclusion. BDC remains one of the rare aggressive subtypes of RCC, having a multitude of initial clinical presentations and an unfavorable prognosis. In this patient, CDC was masquerading as a transitional cell carcinoma that should always be kept in mind as a possible presentation. Corresponding early imaging and histopathology exams are primordial for a correct diagnosis and thus a better prognosis.
