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PubMed1978

[Clinical and morphological findings and problems in malacoplakia of the urinary bladder (author's transl)].

Malacoplakia of the urinary bladder (observations on 4 female patients, average age 47 years, longest duration 8 years) is, under light microscopy, arranged in 4 layers. Zone 1 contains inflammatory granulation tissue. Zone 2 is composed of von Hansemann cells (macrophages). In zone 3, Michaelis-Gutmann bodies appear. Finally, the deepest zone 4 contains connective tissue, blood vessels, and lymphoplasmacellular infiltrates. By electron microscopy, the gradual formation of residual bodies from the remains of phagocytosed materials in the macrophages in these layers can be observed. Through loading with calcium and iron compounds, the residual bodies take on the characteristic appearance of Michaelis-Gutmann bodies. Etiologically, the origin of malacoplakia is probably involved with coliform bacteria, but apparently additional factors are required for the development of a disease process: e.g., disturbance of macrophage function. There are certain parallels between malacoplakia and Whipple's disease. With atypical localization outside the urinary bladder, differential diagnostic difficulties can arise in separating malacoplakia from inflammatory-granulomatous processes (granulomatous orchitis, xanthogranulomatous pyelonephritis). The prognosis of malacoplakia in the urinary bladder is good in all cases, but timely treatment of recurrence and constant supervision are indicated.

Adult↗
PubMed1984

[Value of angiography, sonography and computer tomography in the differential diagnosis of renal space-occupying lesions].

157 space-occupying lesions of the kidneys (89 cysts, 57 malignant tumours, 8 benign tumours, 1 abscess, 1 non-traumatic bleeding and a special form of inflammation, namely, xanthogranulomatous pyelonephritis) which were observed in 2 years, were evaluated, using angiography, ultrasound and computed tomography. If a space-occupying lesion is found--mostly by I.V. urography--ultrasound should be applied next for differentiating the cyst from the solid tumour. If this is not possible, or if a solid tumour is found, the next step should be computed tomography. (Staging of carcinoma, diagnosis of angiomyolipoma or another benign tumour, eg.. a lipoma). Angiography as an invasive procedure is indicated only in cases in which ultrasound and computed tomography don't yield a diagnosis. (Possibility of pharmacoangiography and magnification angiography).

Adenocarcinoma↗
PubMed1995

Urologic cancers in uremic patients.

From 1981 through 1990, 21 urologic cancer cases were discovered in 21 uremic patients at our hospital. This constituted 55% (11 of 20) of the total malignancies in nondialyzed uremic patients, 41% (nine of 22) of the total in chronic hemodialysis patients, and 50% (one of two) of those in patients on continuous ambulatory peritoneal dialysis. No cases of urologic cancer were found in kidney transplant recipients. When compared with the general population, the standardized incidence ratio of kidney cancer in chronic hemodialysis patients was found to be 24.1 (P < 0.01) and that of bladder cancer was found to be 16.4 (P < 0.01). Multiple underlying renal diseases contributed to the development of the urologic cancer cases, including four analgesic nephropathy-associated transitional cell carcinoma cases, two acquired cystic kidney disease-associated renal cell carcinoma cases, two chronic pyelonephritis-associated (stone and tuberculosis) squamous cell carcinoma cases, and one xanthogranulomatous pyelonephritis-associated transitional cell carcinoma case. Uremia per se may be an important promoting factor. Hematuria (17 of 21 cases) was the most common presenting feature despite the fact that most of the patients were anuric. The clinical diagnosis of renal parenchymal tumors was based on ultrasonography (five of five cases), whereas most urothelial tumors were detected by cystoscopy or retrograde pyelography (14 of 16 cases). The survival rate of the 17 aggressively treated patients was 82% at 2 years and 45% at 5 years. We conclude that uremic patients are at greater risk of developing urologic cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

A rare co-existence of focal xanthogranulomatous pyelonepheritis, angiomyolipoma and renal cysts simulating renal cell carcinoma.

A 70-year-old male presented with left flank pain and history of gross, total painless haematuria of 6 months duration. Investigations revealed a large solid and cystic mass suggestive of renal cell carcinoma in left kidney with possible infiltration of left psoas muscle. Histology of radical nephrectomy showed angiomyolipoma with multiple cysts lined by columnar epithelium suggestive of tuberous sclerosis and focal area of xanthogranulomatous pyelonepheritis. The rare combination of such lesions leading to diagnostic dilemma has not been reported in medical literature to the best of our knowledge.

Aged↗
PubMed2000

Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient.

STUDY DESIGN: A case report of xanthogranulomatous funiculitis and epididymo-orchitis. Xanthogranulomatous inflammation is an uncommon, non-neoplastic process characterised by destruction of tissue, which is replaced by a striking cellular infiltrate of lipid-laden macrophages. CASE REPORT: A 21-year male sustained complete tetraplegia at C-6 level, after a fall in 1998. The neuropathic bladder was managed with an indwelling urethral catheter. He had many unsuccessful trials of micturition. Sixteen months after the cervical injury, he noticed swelling of the left side of the scrotum following removal of a blocked catheter. He was prescribed antibacterial therapy. Four weeks later, physical examination revealed a hard and irregular swelling encompassing the testis, epididymis and spermatic cord. The clinical diagnosis was epididymo-orchitis progressing to pyocele. Through a scrotal incision, the swollen testis, epididymis and diseased segment of the spermatic cord were removed en masse. Histopathology showed extensive areas of necrosis, with xanthogranulomatous inflammation in the spermatic cord and to a lesser extent in the testis/epididymis. CONCLUSION: Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding, and subsequent interstitial extravasation of urine together with chronic, low-grade, suppurative infection possibly led to development of xanthogranulomatous inflammation in the testis and the epididymis. Since tissue destruction is a feature of xanthogranulomatous inflammation, the definite and curative treatment is either complete (or, where applicable, partial) excision of the affected organ in most of the cases.

Adult↗
PubMed1995

[A case of soft renal calculi with xanthogranulomatous change].

A case of soft renal calculi with xanthogranulomatous change is reported. A 37-year-old female visited our hospital on February 4, 1992 complaining of frequency of urination and right lower abdominal pain. Under the clinical diagnosis of right renal calculi, extracorporeal shock wave lithotripsy was attempted, but no sign of destruction was observed. Right pyelolithotomy was performed on June 8, 1992. Several soft calculi were removed from the right renal pelvis. Microscopic examination showed that the calculi were surrounded by a cell layer including foam cells and giant cells. In addition, the calculi revealed positive reaction by several stainings (alcian-blue, PAS and muticarmin), which showed that the calculi were mainly composed of mucopolysaccharides. We discussed this disease in terms of symptoms, diagnosis, treatment and mechanism in comparison with previous reports.

Adult↗
PubMed2001

Trauma-related xanthogranulomatous interstitial nephritis: a clinicopathological analysis.

OBJECTIVE: To investigate the pathogenesis, exact nature, histologic feature of xanthogranulomatous interstitial nephritis (XGIN) as well as its significance in clinical medicine. METHODS: The medical histories concerned were collected with diagnostic images including CT scanning, ultrasonography, intravenous urography (IVU) and laboratory data being synthesized by comparison with what was discover ed during operations and pathologic examinations. RESULTS: All patients were ever struck on their loins or backs by blunt violence over 4-12 years. The diseases were clinically diagnosed as "renal cancer" before, during and after operations, and treated with ra dic al nephrectomy. Located at cortical parts, the tumor focus had penetrated the renal capsules and invaded other organs. However, immunohistochemistry demonstrated that the lesions were xanthogranulomas, not tumors, in which there were stacks of foam cells and lymphocytes with vast extends of fibrotic tissues obliterating the cortical interstitial structures. Urinary tracts yielded no bacterium, obstruction or calculus. CONCLUSIONS: XGIN is likely to be one kind of immunologic mediated granuloma following blunt renal trauma. It is imperative to clarify pathogenesis and character of this lesion so as to find out any approach to diagnosis and cure of such an unusual nephropathy.

Adult↗
PubMed1988

Acute and chronic urinary infection: present concepts and controversies.

The current approaches to diagnosing the various renal inflammatory diseases are briefly reviewed. Terminology is varyingly used by different individuals. Our current understanding of these disease processes is discussed in an effort to review the current status of both the mundane and the esoteric infections of the kidney.

Abscess↗
PubMed2000

[The imaging of chronic renal infections].

From pathological point of view the chronic renal infections include two types, interstitial chronic pyelonephritis and granulomatous pyelonephritis, namely xanthogranulomatous, malacoplakia and renal tuberculosis. Indications for imaging modalities are more common compared to the acute types and allow to depict both factors causing obstruction and infection such as stones ant the renal and extrarenal extension of the disease. In this article the authors review the findings and the role of plain film and urography, computed tomography and ultrasonography.

Chronic Disease↗
PubMed2004

[Renal abscess perforated into the thorax].

OBJECTIVE: To present a case of secondary renal abscess to a xanthogranulomatosis pyelonephritis with perforation to chest that required nephrectomy and decortication left pleural. METHODS AND RESULTS: Patient feminine of 38 years that present infections from the tract urinary secondary to kidney lithiasis that evolve to a kidney abscess that you perforates to chest where you forms an abscess. It was treated with nephrectomy and drainage of chest abscess by chest tube, and later decortication, with good evolution. CONCLUSIONS: The kidney abscess and/or xanthogranulomatosis pyelonephritis are the result of a lithiasis not treated obstruction that conditions to the appearance of urinary infection and posterior pyonephrosis and or kidney abscess. The not early detection of the kidney abscess conditions to the perforation to retroperitoneal, intra-abdominal and to chest. The early treatment of the abscess (antibiotics and percutaneous drainage) it can avoid the nephrectomy.

Abscess↗