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Pathology for Urologists

Collecting Duct Carcinoma

Image A
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Image B
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  • High-grade adenocarcinoma (gland forming) believed to arise from collecting duct epithelial cells.
  • Gross:
    • Often centered in medullary region of the kidney with white or gray cut surfaces and central necrosis is common.
    • Demonstrates infiltrative borders. (In contrast to most RCC; this feature is also typical for urothelial carcinoma and metastatic tumors to kidney)
  • Histology:
    • Variable but usually has infiltrative glandular/tubular or papillary architectures (image A) & (image B).
    • Presence of desmoplastic stroma. (In contrast to most RCC)
    • High-grade cytology with abundant mitosis.
    • "Hobnail" appearance of the cells lining (when you can find it).
  • Immunohistochemistry: HMWK+.
  • Aggressive, frequently presents with higher stage or metastasis.
  • ~1/2 of patients dead of disease in 2 years.
  • DDX:
    • Papillary RCC: also has papillae but with histiocytes and is rarely infiltrative or desmoplastic; AMACR+, CK7+ and HMWK-.
    • Urothelial CA: distinction becomes difficult if it has glandular differentiation; look for sheets of typical urothelial carcinoma.
    • Metastatic carcinoma


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