Subepithelial Pelvic Hematoma (Antopol—Goldman Lesion) Simulating Renal Neoplasm: Report of a Case and Review of the Literature

Abstract

The Antopol-Goldman lesion is a subepithelial pelvic hematoma simulating a renal neoplasm. We report the clinico-pathological features of a single case and a review of the literature. A 76-year-old man presented with flank pain and hematuria. Computed tomography showed a hypodense lesion of 6 cm at the left kidney with filling defect at pyelogram. The patient underwent nephroureterectomy for suspected neoplasm. Macroscopically, a mass of 6 cm was present impinging on the pelvi-caliceal system. Microscopically, the lesion was composed by hemorragic material with feature of an hematoma. A diffuse eosinophilic amorphous material suspicious for amyloid was observed among intra- and extraparenchymal vessels. The Congo-Red staining verified the presence of amyloid. The diagnosis was subepithelial pelvic hematoma with severe amyloidosis. Antopol-Goldman lesion should be kept in mind as a possible differential diagnosis of upper urinary tract lesion to avoid unnecessary nephrectomies. The anamnestic knowledge of amiloydosis may increase this diagnostic hypothesis.

Imaging of adrenal and renal hemorrhage

“…The cause is unknown; however, amyloidosis, diabetes mellitus, hypertension, analgesic or anticoagulant use, and trauma have been described as co-factors [30,31]. CT imaging features include non-enhancing, heterogeneous hyperdense masses extending into the renal pelvis that may mimic renal cell or transitional cell carcinoma.…”

“…On non-contrast CT, hyperacute hemorrhage has an attenuation value measuring approximately [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Hounsfield Units (HU) and is similar in attenuation to blood pool. The hyperdense phase occurs a few hours Abdominal Imaging later, with hemorrhage measuring approximately 60-80 HU, due to higher concentration of hemoglobin.…”

Subepithelial pelvic hematoma of the kidney (Antopol-Goldman Lesion)

“…Inclusion of Antopol-Goldman lesion in the differential diagnosis of malignancies has led to an increase in the number of patients followed up with conservative approaches without resorting to nephroureterectomy. [11,12] In a case where hematuria could not be managed conservatively, application of selective arterial embolization was reported. [13] Although, cases diagnosed using only cross-sectional imaging methods, and followed up conservatively have been reported, we couldn't encounter a case presentation in the literature, where use of flexible ureterorenoscopic approach has been reported for diagnostic purposes.…”

“…We have encountered a total of only 41 cases reported in the literature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Typically nearly all of the patients have filling defects detected on imaging methods accompanied with clinical manifestations of painful or painless macroscopic hematuria. Lesion can be frequently localized on renal pelvis, and rarely on the upper ureter, while we haven't encountered a reported case Antopol-Goldman lesion situated in the bladder.…”

The Renal Sinus—Transitional Cell Carcinoma and its Mimickers on Computed Tomography

“…This similarity has resulted in multiple reports of erroneous nephrectomy. 37 It is therefore important to scrutinize the images obtained prior to intravenous contrast administration and if needed manipulate the images digitally to search for the linear hyperdensity outlining the collecting system. In the absence of an un-enhanced scan, a follow-up 2-3 weeks later will usually demonstrate complete resolution of the hemorrhage.…”