黄色肉芽腫性変化を伴った腎カルブンケル例

Abstract

Xanthogranu1omatous pyelonephritis is an unusual form of renal infection in which masses of macrophages with a foamy cytop1asma are found adjacent to areas of chronic suppuration. Most cases reported are associated with pyonephrosis which is obstructed and non-functioning by excretory urography. Eight cases have been reported in Japan. Association with chronic renal abscess which is usually unobstructed, functioning and space-occupying is less common. The type of chronic renal abscess has been more frequently mistaken for renal carcinoma than the type of pyonephrosis by both radiologist and pathologist. A case reported here is the first of the former in our country. Twenty-five-year-old housewife complained of fever and dull pain in left flank for six months and weight loss of 10 kg in the same period. Bacteria and pus in urine were negative. Simple radiography, excretory urography, tomography associated with pneumoretroperitoneum and renal angiography revealed an avascular space-occupying lesion in the upper pole of the left kidney. Left kidney, adrenal gland, spleen and tail of pancreas were markedly adherent with each other, and as biopsy performed revealed a mesenchymal malignancy, all of them were removed en bloc. Surgical specimen revealed renal carbuncle with xanthogranu1omatous change.