Collecting Duct Carcinoma of the Kidney
Are Imaging Findings Suggestive of the Diagnosis?
Perry J. Pickhardt1,2,3,
Cary L. Siegel1 and
John K. McLarney4
1
Mallinckrodt Institute of Radiology, Washington University School of Medicine,
St. Louis, MO 63110.
2
Department of Radiology/Nuclear Medicine, F. Edward
Hébert School of Medicine, Uniformed Services
University of the Health Sciences, Bethesda, MD 20814.
3
Present address: Department of Radiology, National Naval Medical Center,
Bethesda, MD 20889.
4
Department of Radiologic Pathology, Armed Forces Institute of Pathology,
Washington, DC 20306.
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Fig. 1A. —Collecting duct carcinoma in 39-year-old woman. Oblique
conventional radiograph from excretory urography shows smooth convex filling
defect and nonvisualization of upper pole calix (arrows), which
persisted on other views (not shown).
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Fig. 1B. —Collecting duct carcinoma in 39-year-old woman.
Contrast-enhanced CT scan shows ill-defined low-attenuation lesion located
centrally in right kidney (arrowhead). Corticomedullary phase of
contrast excretion persists in this region (arrows); 1.5-cm upper
pole medullary lesion was found at nephrectomy.
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Fig. 2A. —Collecting duct carcinoma in 70-year-old man.
Contrast-enhanced CT scan shows poorly defined mass (M) that replaces normal
renal parenchyma and slightly expands kidney.
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Fig. 2B. —Collecting duct carcinoma in 70-year-old man. Unenhanced
T1-weighted spin-echo MR image obtained at same level as A shows mass
(M) to be isointense to normal renal parenchyma.
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Fig. 3. —Contrast-enhanced CT scan in 72-year-old man shows
low-attenuation mass involving medullary region of right kidney with
protrusion into renal sinus (black arrows). This central tumor
involvement, however, is overshadowed by large exophytic component of even
lower attenuation (white arrows). Note also bulky low-attenuation
modal mass (N) that displaces duodenum anteriorly.
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Fig. 4A. —Cystic variants of collecting duct carcinoma. Delayed
contrast-enhanced CT scan in 14-year-old girl shows complex multilocular
cystic mass (m) replacing large portion of right kidney.
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Fig. 4B. —Cystic variants of collecting duct carcinoma.
Contrast-enhanced CT scan in 59-year-old man shows large unilocular cystic
mass with mural soft-tissue nodules (arrowheads). Protrusion into
renal sinus was seen at other levels (not shown). This was one of only three
cases involving left kidney.
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Fig. 5A. —Collecting duct carcinoma in 36-year-old woman. Longitudinal
sonogram shows hyperechoic mass (arrows) in upper pole of right
kidney. No hypoechoic rim is identified.
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Fig. 5B. —Collecting duct carcinoma in 36-year-old woman. Unenhanced CT
scan shows increased attenuation of lesion (arrows), which measured
59 H.
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Fig. 5C. —Collecting duct carcinoma in 36-year-old woman.
Contrast-enhanced CT scan shows lesion (arrows) to enhance to lesser
degree than surrounding parenchyma. Attenuation value of lesion after contrast
administration measured 78-88 H.
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Fig. 5D. —Collecting duct carcinoma in 36-year-old woman. T2-weighted
spin-echo MR image shows lesion (arrows) to be low in signal
intensity without hypointense rim.
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Fig. 5E. —Collecting duct carcinoma in 36-year-old woman. Photograph of
mass (M) after nephrectomy shows relatively well-defined tumor margin.
Although mass appears grossly expansile, no pseudocapsule was present at
pathologic review. Tumor was characterized by ductular, tubular, and papillary
elements within dense desmoplastic stroma at pathologic examination; no areas
of hemorrhage were present.
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Fig. 6A. —Drawings illustrate infiltrative versus expansile growth of
renal tumors. Infiltrative lesion has expanded kidney (broken line)
but maintains reniform contour. Tumor margin is poorly defined
(arrow).
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Fig. 6B. —Drawings illustrate infiltrative versus expansile growth of
renal tumors. More common expansile tumor is spherical and displaces normal
renal parenchyma. Note also focal bulging of renal contour and presence of
pseudocapsule (arrowheads).
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Copyright © 2001 by the American Roentgen Ray Society.
