CPC #3 Pathology
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CPC #3 Pathology
Radical Nephrectomy
• Three intrarenal masses with cystic change (9, 7, and 5cm)
• Nodular Mass (3cm) in perirenal fat
Not all Renal Tumors (Masses) are Renal Cell Carcinoma!
• Angiomyolipoma
• Oncocytoma
• Xanthogranulomatous Pyelonephritis
• Malakoplakia
• Adrenal Rest
Xanthogranulomatous Pyelonephritis
• Subacute/chronic inflammation forming a mass lesion in the kidney
• Tender unilateral flank mass
• Nephrolithiasis (70%)– Long term recurrent obstruction
• Adults
• Female Predominance (2:1)
Xanthogranulomatous Pyelonephritis
• Gross:– yellow mass often extending into perirenal fat,
mimicking renal cell carcinoma• Microscopic:
– Lipid-laden macrophages– Fibroblastic proliferation– Lymphocytes, plasma cells– Microabscesses
• Microbiology:– Often Proteus mirabilis, E. Coli
CD68
Diagnosis
Xanthogranulomatous Pyelonephritis
ACID-FAST STAIN
ACID-FAST STAIN
Diagnosis
• Xanthogranulomatous Pyelonephritis
• Numerous Acid-fast Bacilli
Similar Cases in Literature
• Shah HN et al. Renal tuberculosis simulating xanthogranulomatous pyelonephritis with contagious hepatic involvement. Int J Urology 2006;13: 67-68.
• Izbudak-Oznur et al. Renal tuberculosis mimicking xanthogranulomatous pyelonephritis: ultrasonography, computed tomography and magnetic resonance imaging findings. Turk J Pediatr 2002;44: 168-171
Important Point
• Immunocompromised patients often do not form granulomas well
• One may see Mycobacterial or Fungal Infections without well-formed granulomas