Difference between revisions of "Kidney tumours"

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Kidney tumours (view source)

Revision as of 12:30, 5 April 2014

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→‎Xanthogranulomatous pyelonephritis: split out
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=Mimics=
=Mimics=
==Xanthogranulomatous pyelonephritis==
==Xanthogranulomatous pyelonephritis==
===General===
*Abbreviated '''XGP'''.
*May mimic [[RCC]] - espically radiologically.
{{Main|Xanthogranulomatous pyelonephritis}}
*Usually lower pole.{{fact}}
*Associated with:
**[[Diabetes mellitus]].
**History of UTI.<ref name=pmid17987581>{{cite journal |author=Afgan F, Mumtaz S, Ather MH |title=Preoperative diagnosis of xanthogranulomatous pyelonephritis |journal=Urol J |volume=4 |issue=3 |pages=169–73 |year=2007 |pmid=17987581 |doi= |url=}}</ref>
**Nephrolithiasis.
**GU obstruction.<ref name=pmid17098659>{{cite journal |author=Al-Ghazo MA, Ghalayini IF, Matalka II, Al-Kaisi NS, Khader YS |title=Xanthogranulomatous pyelonephritis: Analysis of 18 cases |journal=Asian J Surg |volume=29 |issue=4 |pages=257–61 |year=2006 |month=October |pmid=17098659 |doi= |url=}}</ref>
*Occasionally an indication of nephrectomy.<ref name=pmid17987581/><ref name=pmid17098659/>
*Most common organism (in the context of nephrectomy specimens) - ''Proteus mirabilis''.<ref name=pmid17098659/>
 
===Microscopic===
*Abundant macrophages.
*+/-Giant cells.
 
DDx:
*[[Malakoplakia]].
**Basophilic inclusions -- inside or outside of macrophages - often size of RBC or larger ([[Michaelis-Gutmann bodies]]).
*RCC - especially [[PRCC]] (as this has foamy macrophages).
*Granulomatous disease.
*[[Chronic pyelonephritis]].
*[[Interstitial nephritis]].
 
====Image====
<gallery>
Image:Xanthogranulomatous_pyelonephritis_cd68.jpg | Xanthogranulomatous pyelonephritis - CD68 stain. (WC/Nephron)
</gallery>
===Stains===
*[[PAS-D]] -ve.
**Done to look for malakoplakia.
 
===IHC===
*CD68 +ve.
*RCC markers (CD10, RCC) all negative.
 
===Sign out===
<pre>
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).
</pre>
 
====Compatible XGP====
<pre>
"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.
</pre>


==Malakoplakia==
==Malakoplakia==
Michael
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