Sarcoidosis Associated with Renal Masses on Computed Tomography

Abstract

A 50-year-old woman was admitted to our hospital after computed tomography (CT)

Proposal for diagnostic criteria for IgG4-related kidney disease

“…The third step was chosen to confirm an elevated serum IgG4 level, and the following step consisted of two complementary components: radiologic and histopathologic examinations. If renal pathology was not available, a careful differential diagnosis to rule out malignant lymphoma, urinary tract carcinomas, renal infarction, pyelonephritis, Wegener's granulomatosis [17,18], sarcoidosis [19] and metastatic carcinoma was necessary, and non-renal histological finding with infiltrating IgG4-positive plasma cells [10/high power field (HPF) or IgG4/IgG [40% was necessary to support the radiologic findings. As the pathologic examination part, the following characteristic renal pathological findings of IgG4-RKD were listed: (a) marked lymphoplasmacytic infiltration, accompanied by [10 infiltrating IgG4-positive plasma cells/HPF and/or a ratio of IgG4/IgG-positive plasma cells [40%, (b) characteristic fibrosis surrounding several infiltrating cells, (c) other useful findings for the differential diagnosis [positive findings: lesions extending into the renal capsule, eosinophil infiltration, well-defined regional lesion distribution, marked fibrosis, negative findings: (necrotizing) angiitis, granulomatous lesion, neutrophil infiltration, advanced tubulitis].…”

Sarcoidosis presenting as severe renin-dependent hypertension due to kidney vascular injury

“…Indeed, the presence of nodular corticomedullar-located hypodense foci entertained the possibility of a coexisting tumoural process. Only sparse case reports have documented this rare pseudonodular presentation [ 9 – 13 ]. In the even fewer instances where a renal biopsy was conducted, this lesional pattern was almost invariably related to extensive sarcoid granulomatous inflammation as in our case [ 11 – 13 ].…”

“…Only sparse case reports have documented this rare pseudonodular presentation [ 9 – 13 ]. In the even fewer instances where a renal biopsy was conducted, this lesional pattern was almost invariably related to extensive sarcoid granulomatous inflammation as in our case [ 11 – 13 ]. Renal sarcoidosis is usually associated with marked renal impairment on presentation [ 6 ].…”

Renal Mass: A Confusing Feature of Sarcoidosis

“…3 Coalescing granuloma and interstitial mononuclear cell infiltration could be responsible for mass-like aggregate in sarcoidosis. 5,6 GIN is a typical feature of sarcoidosis interstitial nephritis. However, in a retrospective study, 10 out of 47 patients had interstitial nephritis without granulomas.…”

“…Herein, we report another patient who presented with renal dysfunction and renal mass and was finally diagnosed as having renal involvement in sarcoidosis. 5,6 …”