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Case Reports
, 33 (7), 351-5

Collision Tumor of the Kidney Composed of Clear Cell Carcinoma and Collecting Duct Carcinoma: Report of a Case With Unusual Morphology and Clinical Follow-Up

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Case Reports

Collision Tumor of the Kidney Composed of Clear Cell Carcinoma and Collecting Duct Carcinoma: Report of a Case With Unusual Morphology and Clinical Follow-Up

Rhonda Burch-Smith et al. Chin J Cancer.

Abstract

We report the case of a 67-year-old female who presented with a large renal mass. Gross examination of the nephrectomy specimen demonstrated a 6-cm renal mass that invaded into the renal sinus and perinephric fat. Histologic examination revealed two distinct tumor types. The first type was a conventional (clear cell) renal cell carcinoma that was of low nuclear grade and comprised the minority of the overall tumor. The second type was a high-grade collecting duct carcinoma with glandular/tubular differentiation and composed the majority of the tumor. Immunohistochemical studies demonstrated distinctive patterns of the two tumor types, thus confirming two distinct lineages. Five months postoperatively, the patient developed metastasis to the lungs and right hilar lymph node region. A fine needle aspiration of a lung nodule demonstrated a metastatic, poorly differentiated carcinoma, similar to the collecting duct carcinoma component in the kidney. Collision tumors of the kidney are rare with fewer than 10 cases reported in the literature. Our report further expands the spectrum of this rare phenomenon.

Figures

Figure 1.
Figure 1.. Gross picture of the nephrectomy specimen showing two distinct tumor subtypes.
The majority of the tumor is gray-white and fibrotic and demonstrates collecting duct morphology (notched red arrow). Also identified is a soft yellow area that appears to be somewhat sharply demarcated from the above mentioned component, which histologically demonstrates clear cell histology (solid blue arrow).
Figure 2.
Figure 2.. Histologic features of the primary renal tumor as well as the metastatic tumor in the lung.
A, low power image demonstrates a sharp demarcation between the collecting duct carcinoma (top right) and clear cell carcinoma (bottom left). B, high power image demonstrates the low Fuhrman nuclear grade clear cell renal cell carcinoma component. C, the collecting duct carcinoma component is composed of a high-grade tumor with prominent glandular features. The background shows prominent desmoplasia. Also noted are numerous hyaline globules within the tumor. D, fine needle aspiration specimen from the lung metastasis demonstrates high-grade carcinoma. E, cell block preparation demonstrates high-grade carcinoma with histologic features similar to the renal collecting duct carcinoma. Also noted within the aspiration specimen are hyaline globules similar to those noted in the renal primary.
Figure 3.
Figure 3.. Immunohisto-chemical staining profile of the tumor.
A, C, and E demonstrate the collecting duct carcinoma are strongly positive for CK7, Ulex europaeus lectin, and PAX-8, respectively. The clear cell carcinoma is negative for CK7 (B) and Ulex europaeus lectin (D) and is positive for PAX-8 (F).

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