黄色肉芽腫性腎盂腎炎(Xanthogranulomatous pyelonephritis)の1例

Abstract

A 44-year-old female was found to have non-functioning right kidney with a large stone lodged at the ureteropelvic junction. She had had frequent attacks of pyrexia and noted loss of weight for past six months. Right nephrectomy was performed. The specimen showed infected hydronephrosis from which E. coli was isolated. The renal parenchyma was found to be replaced mostly by yellowish granulomatous tissue compatible with xanthogranuloma. Microscopically, there was a striking granulomatous change with aggregation of the foam cells. Infiltration of the plasma cells was prominent. Histochemical stain for lipid showed the foam cells to be compatible with the lipid-laden histiocytes. The patient had normal cholesterol level. As to the pathogenesis of this pathologic condition, no clear conclusion could be made in this particular case. It may, however, be possible that there was a local metabolic disturbance of endogenous lipid due to pyelonephritis which was later handled by phagocytic activity. A brief discussion was made based on the literatures.