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Chemotherapeutic Response with Single Agent Gemcitabine in Metastatic Bellini Duct Tumor

Carcinoma of the collecting ducts or Bellini duct carcinoma remains a highly aggressive tumor with poor prognosis. An article by Chao et al. described the successful resectability of localized collecting duct cancers with favorable long-term follow-up. However, the sensitivity of this disease to conventional chemotherapy remains poor, although several case reports suggest a modest impact on metastatic disease with no benefit on survival. The treatment of this disease has been mainly surgical, although in many instances, the disease is widely metastatic at presentation. Given the rapidly aggressive nature of the disease, chemotherapeutic interventions have now become a mainstay of primary treatment given its behavior which favors it more as bladder cancer than a renal neoplasm. We report the treatment of a young man with Bellini duct cancer with gemcitabine with an overall survival of 22 months from time of diagnosis. The patient is a 23-year-old African-American male college student without significant past medical history who presented in the latter part of 1998 with increasing fatigue and shortness of breath. Family history was remarkable for a father who died at age 51 of a myocardial infarction and a half-sister who died of a round cell tumor of the abdomen in 1998. In early 1999, he experienced fever, a 10-pound weight loss, and back pain, at which time he was seen by the Student Health Service of his college and referred for routine blood work which was unremarkable. In the interim, he was seen in a local emergency room and treated for dehydration. He was seen in February 2000 by a local physician, who noted splenomegaly and renal insufficiency (Bun 17, Cr 1.7) with LDH 1004, HGB 10.6, with normal liver function tests. Monospot, HBsAg, HBSAb, HepC, and HAV tests were negative. Echocardiogram showed normal ejection fraction between 50% and 70% with mild TR, PR, and MR. Computed tomography (CT) scan performed locally showed a large heterogeneous lobulated mass with an exophytic component arising from the upper pole of