Xanthogranulomatous Pyelonephritis Associated with Renal Carcinoma

Abstract

The first case of xanthogranulomatous pyelonephritis associated with renal carcinoma is reported. Differentiation of the 2 entities clinically may be difficult and, since treatment regimens recommended in the past have included partial nephrectomy in cases of limited xanthogranulomatous pyelonephritis, one must hereafter be aware of such a combination when considering such a therapeutic modality.

Xanthogranulomatous Pyelonephritis: King Faisal Specialist Hospital Experience

“…Similarly, association of XPN with amyloidosis has been reported in only two patients [23,24]. Renal cell carcinoma in association with XPN is also rare with only 11 previously reported cases [23][24][25][26][27][28][29][30][31][32].…”

Complicated Upper Urinary Tract Infection

“…The usual differential diagnoses for xanthogranulomatous pyelonephritis are Wilms tumor, renal cell carcinoma, renal abscess, infected renal cystic disease, tuberculosis, malakoplakia, and transitional renal cell carcinoma. There have also been the reports of cases associated with renal carcinoma [148,155]. Differentiation between xanthogranulomatous pyelonephritis presented with massive pelvic dilation and pyonephrosis is not possible.…”

“…To make the diagnosis solely on the basis of frozen section could be difficult as the lipidladen macrophages associated with xanthogranulomatous pyelonephritis are very similar to clear cell adenocarcinoma. There also seems to be relations between the cells in xanthogranulomatous pyelonephritis and renal cell carcinoma, papillary transitional cell carcinoma of the pelvis or bladder, and infiltrating squamous cell carcinoma of the pelvis [148,157]. As a result, nephrectomy should be performed if malignant renal tumor cannot be ruled out.…”

“…As a result, nephrectomy should be performed if malignant renal tumor cannot be ruled out. In case of an encounter with enlarged lymph nodes, the nodes should be dissected to exclude coexisting renal cell carcinoma [148]. If there is a diffuse and extensive disease that extends to the retroperitoneum, nephrectomy accompanied by the removal of the perinephric fat and the dissection of granulomatous tissue from the diaphragm, great vessels, and bowel may be required.…”

“…XPN has been known to imitate virtually every other inflammatory disease of the kidney and on radiographic examination it is usually mistaken for renal cell carcinoma [147]. Moreover, because of the confusing microscopic similarities between xanthogranulomatous and clear cell adenocarcinoma of kidney on frozen section, it has ended in radical nephrectomy [145,147,148].…”