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LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 229-230
Bellini duct carcinoma accidentally found upon investigation of uric acid lithiasis


1 Department of Urology, Tzaneio General Hospital of Pireas, Pireas, Greece
2 Department of Pathology, Tzaneio General Hospital of Pireas, Pireas, Greece

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Stamatiou K, Zizi-Sermpetzoglou A. Bellini duct carcinoma accidentally found upon investigation of uric acid lithiasis. Indian J Pathol Microbiol 2011;54:229-30

How to cite this URL:
Stamatiou K, Zizi-Sermpetzoglou A. Bellini duct carcinoma accidentally found upon investigation of uric acid lithiasis. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 13];54:229-30. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/229/77425


Sir,

Bellini duct carcinoma is a rare renal epithelial tumor comprising less than 1% of renal malignancies. [1] Although some cases had been reported earlier, [2] it was not recognized as a distinct clinicopathologic entity until 1986 when Lewi and Fleming [3] determined the diagnostic criteria and established it as a separate entity. Since then, over 100 cases have been described. There are no specific symptoms; however, hematuria, flank pain, weight loss, and presence of a palpable mass have been described. [3] Recurrent uric acid lithiasis may be a rare manifestation of Bellini duct carcinoma in certain patients possibly due to deregulation of urine pH by increased absorption of bicarbonate and secretion of protons (H+) into the filtrate.

We report a case of a 59-year-old man who presented to our hospital with a recent history of recurrent left renal colic. Urine analysis revealed strongly acidic urine pH. Up to 50 red blood cells and many crystals of uric acid were also found. The grey scale sonogram of the left kidney showed mild dilatation of the renal pelvis and an ill defined tumor, almost isoechoic to the renal cortex. The tumor was centrally located, with extension to the cortex and did not cause a bulge to the renal outline. On contrast enhanced ultrasonography and on contrast-enhanced magnetic resonance imaging, the tumor was inhomogeneously hypoenhancing [Figure 1]a. There was no evidence of renal vein invasion, extrarenal or lymph nodes, or distant metastasis. A diagnosis of renal cell carcinoma was made. The patient underwent left radical nephrectomy.
Figure 1: (a) Contrast-enhanced ultrasound (CEUS) of the lesion. The tumor is better delineated, and is hypoenhancing compared to renal parenchyma (b) Gross specimen (c) Tubulo-papillary pattern (H and E, ×100) (d) The tumor cells are immunohistochemically positive for CK7 (CK7 ×400)

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The cut surface of the kidney revealed a smooth, grayish-brown 9 × 6 × 5 cm tumor occupied the entire upper pole of the kidney [Figure 1]b. Microscopically the tumor displayed predominantly a tubulopapillary pattern [Figure 1]c. The tubules were lined by a single layer of cuboidal cells. The last were characterized by eosinophilic cytoplasm, high-grade nuclei, and prominent nucleoli [Figure 1]d. The tumor was also associated with marked stromal desmoplasia. Alcian-Blue stain revealed intraluminal mucin in some areas. In immunohistochemistry the tumor cells were positive for vimentin and cytokeratins, including CK7, AE1/3, and 34BE12. Some neoplastic cells were positive for E-cadherin and Leu M1. The neoplastic cells were negative for CK20, CEA and epithelial membrane antigen (EMA), and CD10. The histopathological diagnosis was that of Bellini duct carcinoma of the kidney. The postoperative clinical course was good and the patient is alive and disease free 36 months after surgery.

Generally, Bellini duct carcinoma has a poor prognosis. Metastases to regional lymph nodes, lungs, adrenal glands and liver may be present at presentation. [4] The median survival time has been reported to be approximately 22 months. [5] The most important prognostic factor seems to be the stage of the disease at presentation: patients with metastatic disease had worse overall survival than those with no metastatic disease.

Whether and if recurrent uric acid lithiasis is a manifestation of Bellini duct carcinoma is not known however performance of periodic ultrasound controls in patients with lithiasis enables us to achieve early diagnosis and treatment of "incidentally found" tumors of the kidney.

 
   References Top

1.Murphy W, Beckwith J, Farrow G. Tumors of the kidney, bladder and related urinary structures. In: Rosai J, editor. Atlas of tumor pathology. Wanshington, D.C.: Armed Forces Institute of Pathology; 1994.  Back to cited text no. 1
    
2.Macnilla-Jimenez R, Sanley RJ, Blath RA. Papillary renal cell carcinoma: A clinical, radiologic and pathologic study of 34 cases. Cancer 1976;38:2469-80.  Back to cited text no. 2
    
3.Srigley JR, Moch H. World Health Organization of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2000.  Back to cited text no. 3
    
4.Singh I, Nabi G. Bellini duct carcinoma: Review of diagnosis and management. Int Urol Nephrol 2002;34:91-5.  Back to cited text no. 4
    
5.De la Pena Zarzuelo E, Moreno Sierra J, Bocardo Fajardo G, et al. Collecting duct carcinoma. Personal experience and review of the literature. Arch Esp Urol 2002;55:275-83.   Back to cited text no. 5
    

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Correspondence Address:
Konstantinos Stamatiou
2 Salepoula str., 18536 Pireas
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77425

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