Surgical Pathology Criteria–

Carcinoma of the Collecting Ducts of Bellini

Differential Diagnosis

Metastatic adenocarcinoma must be ruled out clinically and by immunohistochemistry when possible

Papillary Renal Cell Carcinoma Collecting Duct Carcinoma
Lacks desmoplasia Prominent desmoplasia
Circumscribed Infiltrative
Frequently low grade nuclear features High grade nuclear features
CD10, AMACR/Racemase, PN15/gp200 positive CD10, AMACR/Racemase, PN15/gp200 negative

Gland-forming Urothelial Carcinoma Collecting Duct Carcinoma
Adjacent usual urothelial carcinoma or carcinoma in situ frequently present Lacks urothelial components
CK20+, p63+, PAX8 infrequent CK20-, p63 14%, PAX8+

Medullary Carcinoma of the Kidney Collecting Duct Carcinoma
Frequent solid and/or reticular areas Predominantly tubular and papillary
Mean age 20-24 Mean age 50-55
Associated with sickle cell trait/disease No association with sickle cell
INI negative INI positive in 85%
OCT3/4 69% positive OCT3/4 negative
The distinction may be largely clinical as there is considerable morphologic overlap

Mucinous Tubular and Spindle Cell Carcinoma of the Kidney Collecting Duct Carcinoma
Cytologically bland tubules Cytologically highly atypical tubules
Mucinous stroma Desmoplastic stroma
Circumscribed Aggressively invasive

Papillary Renal Cell Carcinoma Collecting Duct Carcinoma
Lacks desmoplasia Prominent desmoplasia
Circumscribed Infiltrative
Frequently low grade nuclear features High grade nuclear features
CD10, AMACR/Racemase, PN15/gp200 positive CD10, AMACR/Racemase, PN15/gp200 negative

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