Collecting duct carcinoma of the kidney: are imaging findings suggestive of the diagnosis?

Abstract

Objective: Collecting duct carcinoma derives from the renal medulla and has an infiltrative growth pattern at pathologic examination. The purpose of our study was to characterize the imaging features of this aggressive malignancy and determine whether the diagnosis can be reliably suggested from imaging findings.

Materials and methods: Radiologic studies from 17 patients with pathologically proven collecting duct carcinoma were analyzed by two reviewers.

Results: The tumors varied in size from 1.5 to 19 cm (mean, 7.7 cm). Medullary involvement was present on CT in 16 (94%) of 17 cases, but cortical involvement or an exophytic component was also present in 15 cases (88%) and 10 cases (59%), respectively. The reniform contour of the kidney was preserved in seven cases (41%) and correlated with a smaller tumor size (p<0.01). Tumors showed an infiltrative appearance on CT in 11 cases (65%), but an expansile component was also present in eight of these cases. A cystic component was present on CT in six (35%) of 17 cases. On sonography, the solid tumor component was hyperechoic to normal renal parenchyma in six of seven cases and isoechoic in the other. On MR imaging, all tumors (4/4) were hypointense on T2-weighted imaging. On urography, all lesions (5/5) distorted the intrarenal collecting system. On angiography, all tumors (3/3) were hypovascular.

Conclusion: Medullary involvement and an infiltrative appearance are common findings on cross-sectional imaging and may suggest the diagnosis of collecting duct carcinoma. In large tumors, however, these features are frequently overshadowed by an exophytic or expansile component that cannot be distinguished from the more common cortical renal cell carcinoma.