Nakamura Hisao, Kuirhara Yasuyuki, Matsushita Kazuhiko, Sakai Akehide, Yamaguchi Toshio, Nakajima Yasuo
Department of Radiology, Yokohama Sakae Kyousai Hospital, Yokohama, Japan.
J Med Case Rep. 2008 Sep 17;2:304. doi: 10.1186/1752-1947-2-304.
Collecting duct carcinoma is a rare type of renal cell carcinoma. The primary is difficult to diagnose on imaging, and metastases are often present on initial presentation. Extensive multiorgan metastases can result in complex presentations that can be difficult to diagnose.
We present two case reports of multiorgan metastases of collecting duct carcinoma that were autopsy confirmed. The first case was a 55-year-old man who presented with fever and abdominal pain. Abdominal computed tomography showed enlargement of the right kidney. Pyelonephritis was considered on the basis of laboratory test results and imaging findings. However, multiple cavitary lesions were found on routine chest radiography. These lesions were biopsied, resulting in a histological diagnosis of metastatic adenocarcinoma. A renal tumor was considered. Transitional cell carcinoma was suspected, which proved to be misdiagnosed and chemotherapy was given accordingly. However, this was not effective and the patient died after 2 months. Autopsy demonstrated the primary tumor to be collecting duct carcinoma, with metastases to lung, liver, spleen, bone marrow, right adrenal gland, and para-aortic lymph node. Computed tomography done while the patient was alive detected lung, liver, and para-aortic lymph node metastases. The second case was a 77-year-old man who presented with fever. Pyelonephritis was considered on the basis of the laboratory test results and imaging findings. Antibiotic therapy improved his symptoms and laboratory indicators of inflammation. One year later, he developed backache. Computed tomography revealed a progressively enlarging right renal lesion, multiple liver masses, enlargement of the para-aortic lymph nodes, and multiple osteoblastic and osteoclastic lesions. A renal tumor with multiple metastases was diagnosed. Chemotherapy was given without effect, and the patient died of cardiac failure 1 year later. Autopsy revealed a primary tumor of collecting duct carcinoma with metastases to the liver, right adrenal gland, right upper ureter, bone marrow, para-aortic and mediastinal lymph nodes, and bone.
We present the radiological findings of lung, liver, lymph node, and bone metastases in two patients with collecting duct carcinoma.
集合管癌是一种罕见的肾细胞癌类型。其原发灶在影像学上难以诊断，且在初次就诊时往往已有转移。广泛的多器官转移可导致复杂的临床表现，难以诊断。
我们报告两例经尸检证实的集合管癌多器官转移病例。第一例为一名55岁男性，表现为发热和腹痛。腹部计算机断层扫描显示右肾增大。根据实验室检查结果和影像学表现考虑为肾盂肾炎。然而，常规胸部X线检查发现多个空洞性病变。对这些病变进行活检，组织学诊断为转移性腺癌。考虑存在肾肿瘤。怀疑为移行细胞癌，结果诊断错误并相应给予了化疗。但化疗无效，患者2个月后死亡。尸检显示原发肿瘤为集合管癌，转移至肺、肝、脾、骨髓、右肾上腺和主动脉旁淋巴结。患者生前进行的计算机断层扫描检测到肺、肝和主动脉旁淋巴结转移。第二例为一名77岁男性，表现为发热。根据实验室检查结果和影像学表现考虑为肾盂肾炎。抗生素治疗改善了他的症状和炎症实验室指标。1年后，他出现背痛。计算机断层扫描显示右肾病变逐渐增大，多个肝脏肿块，主动脉旁淋巴结肿大，以及多个成骨和破骨病变。诊断为伴有多处转移的肾肿瘤。给予化疗无效，患者1年后死于心力衰竭。尸检显示原发肿瘤为集合管癌，转移至肝、右肾上腺、右输尿管上段、骨髓、主动脉旁和纵隔淋巴结以及骨骼。
我们展示了两名集合管癌患者肺、肝、淋巴结和骨转移的影像学表现。
