A Rare Case Mimicking Collecting System Tumor: Antopol-Goldman Lesion

Abstract

Antopol-Goldman (AG) lesion is a benign condition characterized by flank pain, hematuria, and radiologically detected filling defect in the renal pelvis. It is clinically important because it is confused with renal parenchymal and collecting system tumors. In this case report, we present a 75-year-old male patient who was evaluated with the suspicion of renal pelvis tumor but was diagnosed with AG lesion and treated conservatively after excluding malignancy with radiology, endoscopy, and pathology. Our aim is to emphasize the importance of diagnostic flexible ureterorenoscopy before planning radical treatment in patients with hematuria, flank pain, and radiological signs of filling defect in the renal pelvis.

Antopol Goldman lesion: A case report

“…In our case, the hematoma occupied the lower calyx and the renal pelvic. Most reported cases were unilateral, affecting the elderly without propensity toward gender or specific side [ 3 , 4 ]. However, the patient in our case was 17 years old, considered much younger than the age that AGL patients present in [4] .…”

“…Nevertheless, a strong correlation with various factors was established throughout reported cases over time [1] . These factors include diabetes mellitus, hypertension, non-steroidal anti-inflammatory drugs, anticoagulants, hemophilia, amyloidosis, trauma, congenital malformations, and others ( 1 , 3 ). Furthermore, as in our case, hematuria and flank pain are considered characteristics of patients with AGL, as they are found in most cases with minor differences in their character [ 2 , 6 ].…”

“…As it was challenging to distinguish AGL from renal and collecting system tumors based on imaging techniques, histopathological examination after nephrectomy was the diagnostic modality at the beginning [ 3 , 4 ]. Due to this, many unnecessary nephrectomies were done for patients with AGL [ 1 , 6 ].…”

“…Due to this, many unnecessary nephrectomies were done for patients with AGL [ 1 , 6 ]. However, as reported cases increased, clinical presentation and radiological findings such as Computer Tomography (CT) scan and Ultrasound (US) became the mainstay of diagnosis [1] , [2] , [3] . Imaging modalities may demonstrate a filling defect, mural thickening, and luminal narrowing of the renal pelvis and proximal ureters, which may be misdiagnosed as a tumor.…”

“…It is described as a renal pelvis subepithelial hematoma or hemorrhage [ 1 , 2 ]. However, it may involve the renal calyces and proximal ureter [ 3 , 4 ]. Although several factors, such as excessive analgesic or anticoagulant medication use, diabetes mellitus, hypertension, hemophilia, etc., were linked to the development of this lesion, the definitive cause is not well established yet [ 1 , 5 ].…”