Xanthogranulomatous Pyelonephritis: An Uncommon Case Report Mimicking Sarcomatoid Renal Cell Carcinoma

  • Ruchi Agrawal Department of Pathology, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat
  • Kulwant Singh Department of Pathology, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat
  • Parul . Department of Pathology, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat
  • Sunaina Hooda Department of Pathology, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat
  • Parveen Rana Department of Pathology, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat
  • Swaran Kaur Saluja Department of Pathology, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat
DOI: https://doi.org/10.21276/apalm.3324
Keywords: Chronic pyelonephritis, cytokeratin, sarcomatoid renal cell carcinoma, xanthogranulomatous pyelonephritis

Abstract

Introduction: Xanthogranulomatous pyelonephritis (XGP) is an atypical form of chronic pyelonephritis characterized by the destruction of renal parenchyma and its replacement with a chronic inflammatory infiltrate of xanthoma cells. Case Report: A 46-year-old male presented in the surgery outpatient department with abdominal pain and recurrent fever. Contrast-enhancing computed tomography (CECT) revealed a lobulated, irregularly shaped, heterogeneously enhancing lesion in the left kidney arising from the upper pole with mitotic activity. Left total nephrectomy was performed, and the specimen was sent for histopathology. The specimen measured 12x8.5x5.3cm. Grossly, a globular mass lesion measuring 9x7x2.4 cm was observed at the upper pole of the kidney. On cutting, an unencapsulated grey-white solid mass with ill-defined margins was identified in the upper pole of the kidney. Microscopically, sheets and bundles of oval to spindle-shaped cells amidst chronic inflammatory infiltrate and giant cells were seen. These cells exhibited moderate pleomorphism with large vesicular nuclei, irregular nuclear margins, clumped chromatin, and pale to eosinophilic ample cytoplasm. Immunohistochemistry (IHC) revealed strong positivity for both vimentin and CD68 and negativity for cytokeratin, CD10, and desmin. The final diagnosis of XGP was made. Conclusion: XGP has earned the title of the "great imitator" due to its overlapping gross and microscopic features with renal cell carcinoma (RCC). This overlap often leads to a delay in reaching a specific diagnosis. However, immunohistochemistry (IHC) helps to avoid such misdiagnoses in the majority of cases.

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Published
07-05-2024
Issue
Vol 11 No 5 (2024)
Section
Case Report

Copyright (c) 2024 Parul Parul, Ruchi Agrawal, Kulwant Singh, Sunaina Hooda, Parveen Rana, Swaran Kaur Saluja

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