A case of focal xanthogranulomatous pyelonephritis difficult to differentiate from renal cell carcinoma
| Autor: | Araki, Motoo, Hashimoto, Yasunobu, Nanri, Masayuki, Onituka, Shiro, Ryoji, Osamu, Nakazawa, Hayakazu, Toma, Hiroshi, Yamaguchi, Yutaka |
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| Jazyk: | japonština |
| Rok vydání: | 2002 |
| Předmět: | |
| Zdroj: | 泌尿器科紀要. 48(10):621-624 |
| ISSN: | 0018-1994 |
| Popis: | 34歳女.左側腹部痛が出現し, 超音波で左腎上極に内部低エコーの腫瘤を認めた.腫瘍の辺縁はMRIのT1強調像で等, T2強調像で低信号を示し, dynamic phaseで不均一に造影された.腹部造影CTでは左腎上極に内部に嚢胞を伴う2.8×4.0cmの辺縁不整な腫瘍を認め, 後期相で造影効果を示した.腫瘍は脾臓へ直接浸潤しており, 2ヵ月前のCTで認めなかった径2cmの傍大動脈リンパ節の嚢胞性腫脹を認めた.尿路に器質的異常は認めず, 腎細胞癌を疑って根治的左腎摘除術を行った.術中腎門部から大動脈に沿って径1cm以下の比較的柔らかいリンパ節が数珠状となっており, これを郭清した.左腎上極は脾尾部及び一部横隔膜と強固に癒着しており, これらを合併切除した.腫瘍は1.8×1.5cmで, 黄色を呈し, 内部に嚢胞を伴っていた.病理組織学的所見で, 泡沫細胞の密な細胞が自壊した腎盂側から腎全層及び周囲脂肪織内に広がっていた.術後経過良好で9日目に退院した A 34-year-old female with left flank pain persisting for 3 months consulted us on 19 Feb, 2001. Ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI) and renal angiography revealed a cystic renal tumor in the upper pole of the left kidney invading the spleen, and paraaortic lymph node swelling. Left radical nephrectomy combined with splenectomy and partial diaphragmectomy was performed under a tentative diagnosis of renal cell carcinoma. However, histopathological findings revealed xanthogranulomatous pyelonephritis (XGP). XGP is a rare, severe, chronic inflammatory disease characterized by accumulation of lipid laden macrophages. XGP is classified as diffuse or focal type. Preoperative diagnosis of focal XGP is difficult because of radiological similarities to renal cell carcinoma. Our case was more difficult to diagnose because she showed few signs of inflammation and had no history of urinary tract infection or stones. |
| Databáze: | OpenAIRE |
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