CPC

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CPC 3 Pathology

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Radical Nephrectomy

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

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Not all Renal Tumors (Masses) are Renal Cell
Carcinoma!

• Angiomyolipoma
• Oncocytoma
• Xanthogranulomatous Pyelonephritis
• Malakoplakia
• Adrenal Rest

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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 (21)

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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

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CD68
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Diagnosis

• Xanthogranulomatous Pyelonephritis

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ACID-FAST STAIN
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ACID-FAST STAIN
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Diagnosis

• Xanthogranulomatous Pyelonephritis
• Numerous Acid-fast Bacilli

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Similar Cases in Literature

• Shah HN et al. Renal tuberculosis simulating
  xanthogranulomatous pyelonephritis with
  contagious hepatic involvement. Int J Urology
  200613 67-68.
• Izbudak-Oznur et al. Renal tuberculosis mimicking
  xanthogranulomatous pyelonephritis
  ultrasonography, computed tomography and magnetic
  resonance imaging findings. Turk J Pediatr
  200244 168-171

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Important Point

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