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CPC #3 Pathology

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.

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CPC #3 Pathology

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  1. CPC #3 Pathology

  2. Radical Nephrectomy • Three intrarenal masses with cystic change (9, 7, and 5cm) • Nodular Mass (3cm) in perirenal fat

  3. Not all Renal Tumors (Masses) are Renal Cell Carcinoma! • Angiomyolipoma • Oncocytoma • Xanthogranulomatous Pyelonephritis • Malakoplakia • Adrenal Rest

  4. 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)

  5. 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

  6. CD68

  7. Diagnosis Xanthogranulomatous Pyelonephritis

  8. ACID-FAST STAIN

  9. ACID-FAST STAIN

  10. Diagnosis • Xanthogranulomatous Pyelonephritis • Numerous Acid-fast Bacilli

  11. 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

  12. Important Point • Immunocompromised patients often do not form granulomas well • One may see Mycobacterial or Fungal Infections without well-formed granulomas

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