Surgical Pathology Criteria

Collecting Duct Carcinoma

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
May show areas of squamous differentiation No squamous differentiation
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

Tubulocystic Carcinoma of the Kidney Collecting Duct Carcinoma
Lacks invasion and desmoplastic stroma Prominent invasion and desmoplastic stroma
Prominently dilated, cystic spaces Predominantly tubules
Lacks necrosis and mitotic figures Frequent necrosis and mitotic figures
Infrequent metastases Frequent metastases at presentation

Hereditary Leiomyomatosis RCC Papillary Renal Cell Carcinoma

FH Negative, 2SC Overexpressed

FH intact, No 2SC over expression

CK7 negative

CK7 positive

Prominent eosinophilic nucleoli
with a clear perinucleolar halo

May have prominent nucleoli

Foamy macrophages uncommon

Foamy macrophages common

Average age 36

Average age 60

  • Both may show predominantly papillary architecture
  • HLRCC-associated RCC more likely to resemble Type 2 PRCC with larger tumor cells, often with higher nuclear grade and eosinophilic cytoplasm
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