title: Extrarenal multiorgan metastases of collecting duct carcinoma of the kidney: a case series.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  We present the radiological findings of lung, liver, lymph node, and bone metastases in two patients with collecting duct carcinoma.
authors.affiliation: Department of Radiology, Yokohama Sakae Kyousai Hospital, Yokohama, Japan. hichaon@qg7.so-net.ne.jp
authors.forename: Hisao
authors.initials: H
authors.lastname: Nakamura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kuirhara
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Matsushita
authors.forename: Akehide
authors.initials: A
authors.lastname: Sakai
authors.forename: Toshio
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Nakajima
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