In renal cell carcinoma (RCC), the Fuhrman nuclear grade (now largely replaced by WHO/ISUP grading) correlates with prognosis. Which histological subtype of RCC carries the WORST prognosis?
- A Clear cell (conventional) RCC
- B Papillary type 1 RCC
- C Collecting duct (Bellini duct) carcinoma ✓
- D Chromophobe RCC
Correct answer: C. Collecting duct (Bellini duct) carcinoma
Explanation
Collecting duct carcinoma (Bellini duct carcinoma) is a rare but highly aggressive variant of RCC arising from the collecting duct epithelium. It typically presents at an advanced stage and carries 5-year survival rates below 10%, the worst prognosis among RCC subtypes. Chromophobe RCC has the best prognosis; papillary type 1 has intermediate-good prognosis; clear cell RCC accounts for ~75% of cases with variable prognosis related to grade and stage. Medullary carcinoma of the kidney (associated with sickle cell trait) is even more aggressive but is distinct.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.