title: Is there a place for radical nephrectomy in the presence of metastatic collecting duct (Bellini) carcinoma?
abstract: OBJECTIVE
  We describe diagnostic and therapeutic characteristics, and long-term followup of collecting (Bellini) duct carcinoma.
  
  
  METHODS
  Ten patients underwent surgery, including radical nephrectomy in 9 and partial nephrectomy in 1, for collecting duct carcinoma diagnosed by histological and immunohistochemical criteria.
  
  
  RESULTS
  Collecting duct carcinoma, which represented 1.3% of renal cell carcinomas diagnosed between 1986 and 1999, developed at a mean patient age of 66.2 years (range: 50.7 to 81). It was detected clinically but never because of macroscopic hematuria. Mean tumor size was 94 mm. (range 30 to 150). Stage was pT3, pT2 and pT1 in 7, 1 and 2 cases, respectively. Seven patients had lymph node or extranodal metastases, and 8 and 2 had Fuhrman grades 3 and 4 disease, respectively. Eight patients died, including 3 early during the perioperative or postoperative period, which was attributable to major surgical difficulties associated with these invasive tumors. Two of the 3 patients who did not have metastases were alive 99 and 100 months after surgery, respectively. Median overall survival +/- SD was 9 +/- 6 and 6 +/- 8 months for patients with metastases. The all survival rate was 20% at 2 years.
  
  
  CONCLUSIONS
  Most collecting duct carcinomas are already metastatic at presentation. Because the prognosis is dismal despite radical nephrectomy, biopsy should be performed first when radiological findings are suggestive of collecting duct carcinoma. For metastatic collecting duct carcinoma radical nephrectomy alone does not seem to be useful except for palliative reasons or in the framework of new multicentric chemotherapy protocols in progress.
authors.affiliation: Department of Urology, Hospital Necker, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Frédérique
authors.initials: F
authors.lastname: Larousserie
authors.forename: Vincent
authors.initials: V
authors.lastname: Hopirtean
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thiounn
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dufour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007685:Kidney Tubules, Collecting / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D015996:Survival Rate