Difference between revisions of "Xanthogranulomatous pyelonephritis"

From Libre Pathology
Jump to navigation Jump to search
(+infobox)
Line 1: Line 1:
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Xanthogranulomatous_pyelonephritis_cd68.jpg
| Width      =
| Caption    = Xanthogranulomatous pyelonephritis. CD68 immunostain.
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[malakoplakia]], RCC - especially [[PRCC]], granulomatous disease, [[chronic pyelonephritis]], [[interstitial nephritis]]
| Stains    = [[PAS-D]] -ve
| IHC        = CD68 +ve, CD10 -ve, pankeratin -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[kidney]] - see ''[[kidney tumours]]''
| Assdx      = [[diabetes mellitus]], history of UTI, [[nephrolithiasis]], GU obstruction (various causes)
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      = dilated upper GU system
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = [[renal cell carcinoma]], [[pyelonephritis]]
| Tx        = antibiotics, occasionally nephrectomy
}}
'''Xanthogranulomatous pyelonephritis''', abbreviated '''XGP''', is an inflammatory process of the [[kidney]] that can mimic [[renal cell carcinoma]].
'''Xanthogranulomatous pyelonephritis''', abbreviated '''XGP''', is an inflammatory process of the [[kidney]] that can mimic [[renal cell carcinoma]].



Revision as of 20:29, 5 April 2014

Xanthogranulomatous pyelonephritis
Diagnosis in short

Xanthogranulomatous pyelonephritis. CD68 immunostain.
LM DDx malakoplakia, RCC - especially PRCC, granulomatous disease, chronic pyelonephritis, interstitial nephritis
Stains PAS-D -ve
IHC CD68 +ve, CD10 -ve, pankeratin -ve
Site kidney - see kidney tumours

Associated Dx diabetes mellitus, history of UTI, nephrolithiasis, GU obstruction (various causes)
Prevalence uncommon
Radiology dilated upper GU system
Clin. DDx renal cell carcinoma, pyelonephritis
Treatment antibiotics, occasionally nephrectomy

Xanthogranulomatous pyelonephritis, abbreviated XGP, is an inflammatory process of the kidney that can mimic renal cell carcinoma.

General

Microscopic

  • Abundant macrophages.
  • +/-Giant cells.

DDx:

Image

Stains

  • PAS-D -ve.
    • Done to look for malakoplakia.

IHC

  • CD68 +ve.
  • RCC markers (CD10, RCC) all negative.

Sign out

RIGHT KIDNEY, NEPHRECTOMY:
- XANTHOGRANULOMATOUS PYELONEPHRITIS.
- CHRONIC INTERSTITIAL NEPHRITIS.
- INCREASED NUMBERS OF TOTALLY SCLEROSED GLOMERULI AND GLOMERULI WITH FOCAL 
  SEGMENTAL GLOMERULOSCLEROSIS.
- MARKED INTERSTITIAL FIBROSIS.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
Immunostaining demonstrates abundant CD68 positive cells (macrophages).  A CD10 immunostain 
is non-concerning (it highlights glomeruli). A pankeratin immunostain is non-concerning 
(it highlights benign renal tubules).

Compatible XGP

"KIDNEY" LESION, LEFT, BIOPSY:
- FIBROMUSCULAR TISSUE WITH A MIXED INFLAMMATORY INFILTRATE.
- CELLULAR DEBRIS WITH SURROUNDING LOOSELY AGGREGATED HISTIOCYTES.
- NO RENAL PARENCHYMA IDENTIFIED.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
A SMA immunostain highlights the muscle component, and a CD68 immunostain marks 
abundant histiocytes. No epithelial component is identified with a pankeratin 
immunostain. 

See also

References

  1. 1.0 1.1 Afgan F, Mumtaz S, Ather MH (2007). "Preoperative diagnosis of xanthogranulomatous pyelonephritis". Urol J 4 (3): 169–73. PMID 17987581.
  2. 2.0 2.1 2.2 Al-Ghazo MA, Ghalayini IF, Matalka II, Al-Kaisi NS, Khader YS (October 2006). "Xanthogranulomatous pyelonephritis: Analysis of 18 cases". Asian J Surg 29 (4): 257–61. PMID 17098659.