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PubMed2006

Primary renal inflammatory malignant fibrous histiocytoma: a diagnostic challenge.

Renal inflammatory malignant fibrous histiocytoma (MFH) is an extremely rare lesion and is a great masquerader of common benign renal inflammatory lesions, especially xanthogranulomatous pyelonephritis (XGPN). The clinical presentation of mass with fever and peripheral leucocytosis (marked at times), and marked inflammatory, predominantly neutrophilic, infiltrate obscuring the malignant cells on histopathology, can lead to delay in the diagnosis of this poor prognostic malignant tumor. We present the case of a patient who underwent radical nephrectomy with a clinical diagnosis of renal malignancy, but histopathology showing XGPN. The patient showed an initial clinical response, only to recur two times, ultimately leading to a histological and immunohistochemical diagnosis of inflammatory MFH. The diagnosis, histology, therapeutic options and prognosis of this rare lesion are discussed.

Diagnosis, Differential↗

PubMed1998

Spontaneous regression of renal cell carcinoma: a pitfall in diagnosis of renal lesions.

Two cases of renal cell carcinoma, both of which underwent extensive spontaneous regression, are reported. The first occurred in a 56 year old man, forming a well circumscribed renal cortical nodule which contained only very occasional foci of viable renal cell carcinoma with areas of hyalinisation and calcification, and with metaplastic ossification. The second lesion was removed from an 82 year old man, comprising a cystic cavity containing necrotic debris with only occasional viable foci of classical renal cell carcinoma. Spontaneous regression of renal cell carcinoma is a rare but recognised entity. These two cases emphasise the important differential diagnoses: metastatic secondary carcinomas, xanthogranulomatous pyelonephritis, and infective granulomatous conditions of the kidney. The importance of adequate tissue sampling of all renal nodules cannot be overemphasised in the processing for examination of lesions within the kidney.

Aged↗

PubMed1979

Calyceal diverticula in children: unusual features and complications.

Calyceal diverticulum is a relatively rare lesion that is usually asymptomatic but can assume clinical significance if drainage is impaired. Three patients are presented with unusual complications directly referable to a calyceal diverticulum. One child had a mobile calculus. In 2 others, intrarenal inflammatory masses developed in the area previously occupied by a calyceal diverticulum. One of these children had proved xanthogranulomatous pyelonephritis, and the other had an infected diverticulum.

Abscess↗

PubMedDate not supplied

Diagnosis of renal malacoplakia by fine needle aspiration cytology. A case report.

BACKGROUND: Malacoplakia is a rare chronic inflammatory disease first described by von Hansemann in 1901. L. Michaelis and M. Gutmann published the first report in 1902, describing the characteristic round intracellular and extracellular inclusions, or Michaelis-Gutmann bodies. Renal malacoplakia is a form of chronic tubulointerstitial nephritis the clinical and radiologic findings of which are often suggestive of a neoplasm. Renal malacoplakia may be related to megalocytic interstitial nephritis and xanthogranulomatous pyelonephritis. CASE: A 67-year-old male presented with acute left loin pain suggestive of uretery colic. The past medical history was unremarkable and physical examination within normal limits. Renal ultrasound and computed tomography showed a 3.5-cm, cystic mass with a thickened, irregular wall located centrally within the left renal sinus. The size of the left kidney was 11.5 cm. A renal arteriogram provided no evidence of a vascular mass of any type. Fine needle aspiration (FNA) revealed many large, foamy, granular macrophages with large, eccentric nuclei and prominent nucleoli containing round inclusions that exhibited a laminated appearance, consistent with the structure of Michaelis-Gutmann bodies. Many were also present extracellularly. CONCLUSION: To our knowledge this is the first case of renal malacoplakia diagnosed by fine needle aspiration. This case demonstrates the value of FNA in determining the nature of a radiologically nonspecific lesion. It highlights the value of FNA as a substitute for or preliminary method before more invasive procedures in the diagnosis of a treatable disease entity.

Aged↗

PubMed1976

Roentgenology-pathology correlative study of neovascularity.

In an attempt to evaluate the histologic picture of what is shown on angiograms as neovascularity, several benign and malignant tumors were examined. New vessels (neovascularity) are large capillaries or sinusoids, and neither contain smooth muscle in their walls. The walls may contain some fibrous connective tissue. Puddling, laking, and staining represent the collection of contrast medium in small capillaries or sinusoids. Some tumors, such as hemangioma of the liver, cystadenoma of the pancreas, and angiomyolipoma of the kidney contained abnormal vascularity, but this was not composed of vessels which had arisen or developed anew, as there was smooth muscle in their walls, and this indicates that those vessels had been there from birth. In xanthogranulomatous pyelonephritis and chronic renal disease, the appearance of increased vascularity is the result of rearrangement of the normal vascular structures.

Angiography↗

PubMed1982

CT of calcified renal masses.

The ability to evaluate the composition and to precisely locate calcifications within renal masses resulted in more accurate evaluation of 21 calcified renal masses by computed tomography than by standard radiographic techniques. Of 11 solid tumors, computed tomography demonstrated a soft-tissue mass extending beyond the calcification in nine cases of renal cell carcinoma. Of 10 benign cystic lesions, all six lesions characterized by a uniform water-density center, calcification confined to the wall, and no detectable soft-tissue mass were benign cysts. Three additional cystic lesions (xanthogranulomatous pyelonephritis, multilocular cystic nephroma, and a cyst containing calcified debris) were believed to represent benign lesions prospectively due to the absence of a soft-tissue mass. Only peripherally calcified lesions with a central attenuation higher than accepted for benign cysts were indeterminate by computed tomography. The significance of the computed tomographic findings in terms of malignant potential and patient management is discussed.

Adenocarcinoma↗

PubMed1977

Renal endometriosis. A case report.

In a 23-year-old woman with lumbar pain, an expansive process in the right kidney was demonstrated by I.V.P., retrograde pyelography and renal angiography. The histological examination subsequent to nephrectomy showed endometriosis in association with localized xanthogranulomatous pyelonephritis. Renal endometriosis has been described only eight times previously in the literature. The current case is discussed and compared with previous reports.

Adult↗

PubMed2001

[Uretero-colonic fistula in non-functioning ureter].

OBJECTIVE: To present a case of ureterocolonic fistula secondary to acute sigmoid diverticulitis in a nonfunctioning ureter due to a previous nephrectomy. METHODS/RESULTS: A 68-year-old patient that had undergone nephrectomy due to xanthogranulomatous pyelonephritis two years earlier, consulted for long-standing non-specific abdominal pain. Radiological evaluation showed a pneumogram pattern in the ureteral stump associated to a pelvic mass. The patient underwent surgery for a suspected uretero-intestinal fistula. The intraoperative findings and anatomopathological study demonstrated a uretero-sigmoid fistula due to diverticular disease of colon. CONCLUSIONS: Uretero-intestinal fistulas present unimportant clinical features. Radiological assessment and a clinical suspicion are important to diagnosis.

Aged↗

PubMed1975

[Angiographic differential diagnosis of hydronephrosis (author's transl)].

The diagnosis of hydronephrosis is made by excretory urography with late films and retrograde pyelography. Renal arteriography in hydronephrosis permits exact evaluation of vascular supply and parenchymal thickness. In three cases selective arteriography was performed because of a non-functioning kidney or suspected space-occupying lesion. The combination of arteriogram and urogram--if necessary together with percutaneous puncture--allows to differentiate between hydronephrosis, avascular tumors, renal cysts, polycystic renal disease, renal abscess, subcapsular renal hematoma, fibrolipomatosis, xanthogranulomatous pyelonephritis, and tuberculosis.

Abscess↗

PubMed2003

[Liposarcoma of the perirenal cell].

OBJECTIVES: To show the imaging tests characteristics and differential diagnosis of masses located within the retroperitoneal perirenal area. METHODS: Diagnostic imaging tests (KUB x-ray, ultrasound, helical CT scan with IV contrast) and follow-up in one case of perirenal cell liposarcoma. RESULTS: The study of the surgical specimen after renal tumorectomy in a patient with a solitary kidney resulted in the present diagnosis. CONCLUSIONS: Liposarcoma is a malignant neoplasia derived from fatty tissue. Approximately 13% are located in the retroperitoneal area, and less than 1/3 arise from perinephric fat. We report one case of liposarcoma located in the perirenal cell as an incidental finding during contralateral psoas muscle abscess follow-up in a patient with a solitary kidney after surgery for xanthogranulomatous pyelonephritis. Successive controls during the last year allowed us to evaluate the evolution of this lesion's.

Female↗

PubMed1992

[Stauffer's syndrome caused by a benign intracystic renal hematoma].

We report a case of Stauffer's syndrome, characterized mainly by cholectasis, that occurred in a patient with benign intracystic renal haematoma and subsided after nephrectomy. Stauffer's syndrome was recognized, in 1961, as a paraneoplastic manifestation, usually associated with hypernephroma. This syndrome has been reported in only 2 cases of benign renal disease, which was a pseudotumoral xanthogranulomatous pyelonephritis.

Cholestasis, Intrahepatic↗

PubMed2005

Preoperative evaluation of renal anatomy and renal masses with helical CT, 3D-CT and 3D-CT angiography.

PURPOSE: The aim of this prospective study was to determine the efficacy of three-dimensional computed tomography (3D-CT) and three-dimensional computed tomographic angiography (3D-CTA) that were reconstructed by using the axial images of the multiphasic helical CT in the preoperative evaluation of renal masses and demonstration of renal anatomy. MATERIALS AND METHODS: Twenty patients that were suspected of having renal masses upon initial physical examination and ultrasonographic evaluation were examined through multiphasic helical CT. Two authors executed CT evaluations. Axial images were first examined and then used to reconstruct 3D-CT and 3D- CTA images. Number, location and size of the renal masses and other findings were noted. Renal vascularization and relationships of the renal masses with the neighboring renal structures were further investigated with 3D-CT and 3D-CTA images. RESULTS: Out of 20 patients, 13 had histopathologically proven renal cell carcinoma. The diagnoses of the remaining seven patients were xanthogranulomatous pyelonephritis, abscess, simple cyst, infected cyst, angiomyolipoma, oncocytoma and arteriovenous fistula. In the renal cell carcinoma group, 3 patients had stage I, 7 patients had stage II, and 3 patients had stage III disease. Sizes of renal cell carcinoma masses were between 23 mm to 60 mm (mean, 36 mm). Vascular invasion was shown in 2 renal cell carcinoma patients. Collecting system invasion was identified in 11 of 13 renal cell patients. These radiologic findings were confirmed with surgical specimens. CONCLUSION: Three-dimensional CT and 3D-CTA are non-invasive, effective imaging techniques for the preoperative evaluation of renal masses.

Adult↗

PubMed1990

[Entero-urinary fistula. A study of 22 cases].

We performed a retrospective study on 22 patients with entero-urinary fistulas that had been diagnosed and treated at the Hospital Clinico i Provincial in Barcelona during the period spanning 1981-1988. Fistulas were classified according to the organs or parts with which they communicated. Among the important etiogenic conditions were diverticular disease of colon. Crohn's disease, actinic lesions, trauma and xanthogranulomatous pyelonephritis. The clinical manifestations were principally urological in the form of recurrent urinary infection and terminal pneumaturia. The most useful diagnostic techniques were cystoscopy; serial voiding cystourethrography (SVCU), retrograde urethrography and pyelography. Treatment was by surgery in all cases. Diversion procedures or surgical excision of the fistulous tract were performed as warranted by each case. The etiopathogenic, morphological and therapeutical aspects of vesico-enteric fistulas are discussed.

Adolescent↗

PubMed1989

[Duodenal obstruction: first manifestation of giant hydronephrosis].

We report a case of giant hydronephrosis from lithiasis and xanthogranulomatous pyelonephritis in a 69-year-old patient, whose presenting symptoms were those of duodenal obstruction.

Aged↗

PubMed1989

[Epidermoid carcinoma of the kidney].

Epidermoid carcinoma of the kidney is a rare malignant tumor, characterized by high invasiveness, poor prognosis, and the association of renal stone and renal infection. Very little reports about its sonographic appearance were mentioned in the literature. We present a case of epidermoid carcinoma of the kidney. Its ultrasonography showed a heterogeneous renal mass with perirenal and pararenal invasion, destruction of the renal pelvis, and preservation of enlarged reniform outline. Although this tumor should be differentiated with renal cell carcinoma, transitional cell carcinoma, renal metastatic tumor, renal lymphoma, renal infarction, focal bacterial nephritis, and xanthogranulomatous pyelonephritis etc., we think we should put epidermoid carcinoma of kidney into consideration when a renal tumor mass presents with perirenal and pararenal invasion, destruction of the renal pelvis, and preservation of enlarged reniform outline in sonography, and hypovascularity in angiographic study.

Adult↗

PubMed1987

Renal and perirenal abscesses.

Our knowledge of the spectrum of renal abscesses has increased as a result of more sensitive radiologic techniques. The classification of intrarenal abscess now includes acute focal bacterial nephritis and acute multifocal bacterial nephritis, as well as the previously recognized renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. In general, the clinical presentation of these entities does not differentiate them; various radiographic studies can distinguish them, however. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy are required for resolution.

Abscess↗

PubMed1987

Contemporary imaging of renal inflammatory disease.

In addition to plain films and conventional excretory urography, ultrasound, computed tomography, and radionuclide scanning may contribute to the assessment of a wide spectrum of renal inflammatory diseases. This article discusses the role of contemporary imaging modalities in the diagnosis and management of patients with renal inflammatory lesions, including acute focal and diffuse bacterial infections, intra- and extrarenal abscess collections, pyonephrosis, xanthogranulomatous pyelonephritis, fungal infection, tuberculosis, and malakoplakia of the upper urinary tract.

Abscess↗

PubMed1985

Malakoplakia of the female genital tract.

A rare case of malakoplakia of the uterine cervix and the pelvis occurring in an elderly woman who also had xanthogranulomatous pyelonephritis is described and compared with the 15 reported cases of malakoplakia of the female genital tract.

Adult↗