XANTHOGRANULOMATOUS PYELONEPHRITIS AND DIAGNOSTIC APPROACH: A CASE REPORT
Abstract
Xanthogranulomatous pyelonephritis (XGPN) is an uncommon chronic granulomatous process that can result in significant destruction of renal parenchyma and propagation of inflammation into adjacent pararenal tissues. The presented patient had xanthogranulomatous inflammation of renal pelvis, peri- and paranephritic tissue, with formation of a large tumor-like mass which was in close relation to the base of urinary bladder. The findings of pathognomonic foamy macrophages and multinucleated giant cells showing diffuse positivity for CD68 confirmed the precise diagnosis. Having in mind that XGPN can mimic various clinically and pathologically benign and malignant conditions, a multidisciplinary diagnostic approach is required. Sometimes, careful clinical, imaging, nuclear and histopathological examinations are necessary to determine the type and degree of renal damage, which will dictate surgical approach, especially if nephrectomy is not planned.
References
Antonakopoulos GN, Chapple CR, Newman J, Crocker J, Tudway DC, O'Brien JM, et al. Xanthogranulomatous pyelonephritis. A reappraisal and immunohistochemical study. Arch Pathol Lab Med 1988;112(3):275-81. [PubMed]
Bolger MP, Hennebry J, Byrne C, Greene L, Stroiescu A, Heneghan J, et al. Xanthogranulomatous pyelonephritis: a narrative review with current perspectives on diagnostic imaging and management, including interventional radiology techniques. Int J Nephro Renovas Disease 2021;14:359-69. [CrossRef][PubMed]
Chlif M, Chakroun M, Rhouma SB, Chehida MAB, Sellami A, Gargouri MM, et al. Xanthogranulomatous pyelonephritis presenting as a pseudotumour. Can Urol Assoc J 2016;10(1-2):E36-40. [CrossRef][PubMed]
Chow J, Kabani R, Lithgow K, Sarna MA. Xanthogranulomatous pyelonephritis presenting as acute pleuritic chest pain: A case report. J Med Case Rep 2017;11:101. [CrossRef][PubMed]
Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics 2008;28(1):255-77. [CrossRef][PubMed]
Khalyl-Mawad J, Greco MA, Schinella RA. Ultrastructural demonstration of intracellular bacteria in xanthogranulomatous pyelonephritis. Hum Pathol 1982;13(1):41-7. [CrossRef][PubMed]
Kobayashi T, Casablanca NM, Harrington M. Pyeloduodenal fistula diagnosed with technetium-99m scintigraphy and managed with a conservative strategy. BMJ Case Rep 2018:bcr2017223425. [CrossRef][PubMed]
Kundu R, Baliyan A, Dhingra H, Bhalla V, Punia RS. Clinicopathological spectrum of Xanthogranulomatous pyelonephritis. Indian J Nephrol 2019;29(2):111-15. [CrossRef][PubMed]
Le X, Wang X-B, Zhao H, Chen R-F, Ge P. Comparison of clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma. BMC Urol 2020;20:148. [CrossRef][PubMed]
Loffroy R, Guiu B, Watfa J, Michel F, Cercueil JP, Krausé D. Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms. Clin Radiol 2007;62(9):884-90. [CrossRef][PubMed]
Morales C, Opazo V, Bassa C, López L, Araos F, Madrid P, et al. Xanthogranulomatous pyelonephritis: A case report. Urol Case Rep 2018;19:65-6. [CrossRef][PubMed]
Motuzko E, Germaine P. Xanthogranulomatous pyelonephritis: the uncommon complications of the uncommon disease. Appl Radiol 2016;45(6):32-4.
Numan L, Zamir H, Husainat NM, Tahboub M. Xanthogranulomatous Pyelonephritis Causing Renocolic fistula presenting as symptomatic anemia. Cureus 2019;11(6):e4947. [CrossRef][PubMed]
Onur MR, Firdolas F, Kocakoç E, Orhan I. Inflammatory pseudotumor of the kidney. J Clin Imag Sci 2011;1:7. [CrossRef][PubMed]
Parsons MA, Harris SC, Longstaff AJ, Grainger RG. Xanthogranulomatous pyelonephritis: a pathological, clinical and aetiological analysis of 87 cases. Diagn Histopathol 1983;6(3-4):203-19. [PubMed]
Ristić Petrović A, Stojnev S, Janković Veličković L, Marjanović G, Stefanović V. Malakoplakia mimics urinary bladder cancer: a case report.
Titus B, Gupta S, Edpao P, Psutka SP, Limaye AP, Bakthavatsalam R, et al. Xanthogranulomatous pyelonephritis with direct extension into the liver. Am J Med 2020;133(9):1054-5. [CrossRef][PubMed]
Zorzos I, Moutzouris V, Korakianitis G, Katsou G. Analysis of 39 cases of xanthogranulomatous pyelonephritis with emphasis on CT findings. Scand J Urol Nephrol 2003;37(4):342-7. [CrossRef][PubMed]
Zorzos I, Moutzouris V, Korakianitis G, Katsou G. Analysis of 39 cases of xanthogranulomatous pyelonephritis with emphasis on CT findings. Scand J Urol Nephrol 2003;37(4):342-7. [CrossRef][PubMed]