Xanthogranulomatous Pyelonephritis: An Uncommon Case Report Mimicking Sarcomatoid Renal Cell Carcinoma
DOI:
https://doi.org/10.21276/apalm.3324Keywords:
Chronic pyelonephritis, cytokeratin, sarcomatoid renal cell carcinoma, xanthogranulomatous pyelonephritisAbstract
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.
References
Goldman SM, Hartman DS, Fishman EK, Finizio JP, Gatewood OM, Siegelman SS. CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation. AJR Am J Roentgenol. 1984 May;142(5):963–9.
Jang TL, McKoy T, Hakim J, Polenakovik HM. Xanthogranulomatous pyelonephritis - A diagnostic and therapeutic dilemma. Am J Med Sci. 2023 Mar;365(3):294-301.
Korkes F, Favoretto RL, Bróglio M, Silva CA, Castro MG, Perez MD. Xanthogranulomatous pyelonephritis: clinical experience with 41 cases. Urology. 2008 Feb;71(2):178–80.
Loffroy R, Guiu B, Watfa J, Michel F, Cercueil JP, Krause Ì D. Xanthogranulomatous pyelonephritis in adults: clinical and radiological findings in diffuse and focal forms. Clin Radiol. 2007 Sep;62(9):884–90.
Li L, Parwani AV. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med. 2011 May;135(5):671–4.
Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008 Jan-Feb;28(1):255-77.
Zorzos I, Moutzouris V, Petraki C, Katsou G. Xanthogranulomatous pyelonephritis--the "great imitator" justifies its name. Scand J Urol Nephrol. 2002;36(1):74-6.
Morais CG, Gomes S, Fragoso AC, Coelho J, Jardim J, Barreira JL et al. Neonatal Urinary Tract Infection and Renal Nodular Lesion: A Rare Case of Xanthogranulomatous Pyelonephritis. J Investig Med High Impact Case Rep. 2022 Oct;10:23247096211066295.
Maiti K, Roy PP, Pal DK. Xanthogranulomatous Pyelonephritis-A Diagnostic Dilemma. J Clin Diagn. 2021 Nov;15(11):01-03.
Rahman MK, Rana S, Jairajpuri ZS, Khetrapal S. Renal cell carcinoma and xanthogranulomatous pyelonephritis: A diagnostic challenge. Arch Med Health Sci. 2018;6:247-50.
Dhingra K, Ghazi T, Osher M. Atypical presentation of focal xanthogranulomatous pyelonephritis. Radiol Case Rep. 2022 Feb;18(2):456-9.
Daoud N, Ismaiel N, Bashour G, Nammour A, Barri A, Alshehabi Z. Xanthogranulomatous pyelonephritis mimicking renal cell carcinoma: a case report. Ann Med Surg (Lond). 2023 Apr;85(4):1254-7.
Ostalska-Nowicka D, Mackowiak-Lewandowicz K, Konwerska A, Zachwieja J. Early Progression of Xanthogranulomatous Pyelonephritis in Children Might Be Dependent on Vimentin Expression. Am J Case Rep. 2017;18:1066-72.
Shah K, Parikh M, Gharia P, Modi PR. Xanthogranulomatous pyelonephritis-mimicking renal mass in 5-month-old child. Urology. 2012 Jun;79(6):1360-2.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Ruchi Agrawal, Kulwant Singh, Parul ., Sunaina Hooda, Parveen Rana, Swaran Kaur Saluja
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
