Coexistence of renal replacement lipomatosis with xanthogranulomatous pyelonephritis

We report on a case of coexistence of replacement lipomatosis with xanthogranulomatous pyelonephritis (XGP) in the same kidney associated with staghorn calculi. A 63-year-old man was admitted to hospital complaining of a right abdominal mass. Computed tomography (CT) showed renal parenchymal atrophy with extremely increased perirenal fat. Right nephrectomy was performed. Postoperative diagnosis was renal replacement lipomatosis with XGP. Renal replacement lipomatosis and XGP have several similarities in terms of clinical background and CT findings. Sometimes it is difficult to differentiate them from malignant diseases. It is extremely rare that both conditions coexist in the same kidney. To our knowledge, only one such case has been reported.     

Replacement kidney lipomatosis after renal transplantation

Renal sinus lipomatosis consists of abnormal fatty proliferation of the renal sinus, hilus, and perirenal spaces. Its pathogenesis is unknown, although it is generally associated with aging, renal atrophy, and long-standing chronic inflammation or urinary tract infection. Although this condition is rare, it may be important to recognize it in renal transplant recipients. We describe three cases of replacement kidney lipomatosis that occurred after cadaveric renal transplantation and discuss the possible differential diagnosis of this condition.     

肾盂脂肪瘤病合并膀胱黄色肉芽肿性膀胱炎一例并文献复习

目的探讨罕见的肾盂脂肪瘤病合并膀胱黄色肉芽肿性膀胱炎病例的发病机制、病理特点、临床表现、诊断和治疗。 方法回顾性分析1例我院收治的肾盂脂肪瘤病合并膀胱黄色肉芽肿性膀胱炎病例临床资料,复习相关文献并予以讨论。患者女,51岁,因"无痛性肉眼血尿6个月"入院,术前拟诊为左肾盂癌伴输尿管膀胱种植转移。 结果先后行膀胱镜检+活检术、经尿道膀胱肿物切除术、3D腹腔镜下左肾切除+左输尿管切除术,术中术后病理结果：左肾盂脂肪瘤病合并膀胱黄色肉芽肿性膀胱炎,术后随访6个月未见异常。 结论肾盂脂肪瘤病和膀胱黄色肉芽肿性膀胱炎均为临床上罕见的良性疾病,同一患者同时合并有这两种疾病的病例暂未见报道。该病需与泌尿系统的其他良恶性肿瘤相鉴别,以便正确诊断与及时治疗。     

Renal hilus lipomatosis simulating carcinoma of the kidney

We report a case of lipomatosis of the renal hilus which presented with macroscopic painless haematuria. The appearance of the pyelocalyceal system on the intravenous urogram set the diagnosis of renal carcinoma, a diagnosis that both ultrasound and computed tomography did not refute. Final diagnosis was established histologically.     

Lipomatosis pélvica: causa de estallido vesical

We have a case of pelvic lipomatosis in a patient suffering from right flank pain and urinary syndrome. Before completing the diagnostic test, abdominal traumatism forced to perform a laparotomy of emergency. We found a great deal of retropubic mass with bladder rupture and thickened walls caused by perivesical fat. The anatomopathological diagnosis was pelvis lipomatosis. This is an unusual case of bladder rupture after slight traumatism     

Fat suppression imaging in epidural lipomatosis: case report

A case of epidural lipomatosis associated with steroid use in rheumatoid arthritis is presented to describe the role of fat suppression imaging as a diagnostic tool. The plain radiographs revealed several vertebral compression fractures and the magnetic resonance imaging (MRI) showed a large extradural mass. A fat suppression MRI was obtained, which confirmed the diagnosis of epidural lipomatosis. A fat suppression MRI scan is a special imaging technique that is used in particular to either suppress the signal from adipose tissue or detect adipose tissue. An MRI scan is the imaging tool of choice to examine soft tissue lesions of the spine, and fat suppression imaging will provide additional information about any fatty soft tissue lesion, as in the case of epidural lipomatosis. This imaging modality is particularly useful in those patients who are morbidly obese or taking exogenous corticosteroids, because these conditions can proliferate adipose tissue leading to epidural lipomatosis.     

Renal sinus lipomatosis: Differentiation from space-occupying lesion with aid of computed tomography

Forty-two cases of renal sinus lipomatosis were diagnosed by intravenous urography and nephrotomography. The differential diagnosis from a malignant process necessitated selective renal angiography in 9 cases. With the aid of computed tomography (CT), an invasive technique such as renal angiography appears to be unnecessary in the differential diagnosis of renal sinus lipomatosis. CT seems to be more accurate since it revealed a concomitant cyst in 2 of 4 cases.     

Diagnostic Difficulties in Diffuse Xanthogranulomatous Pyelonephritis: A Case Report and Review of the Literature

Xanthogranulomatous pyelonephritis is a rare, severe, and chronic infection of the kidney characterized by the replacement of renal parenchyma by the xanthoma cells which is difficult to diagnose radiologically. We report a 40-year-old male who had vague abdominal mass and fever for more than 2 months. Weight loss and fatigue were the associated symptoms. Ultrasonography revealed a grossly enlarged right kidney with replacement of renal parenchyma by multiple hypoechoic areas with perinephric thickening and a large staghorn calculus. An abdominal computed tomogram demonstrated an irregular, enlarged right kidney with multiple low-density round areas and calculi. Diminished excretion of contrast media and a severe perinephric inflammatory reaction were present. A presurgical diagnosis of xanthogranulomatous pyelonephritis was made. First, drainage of the extrarenal abscess under proper antibiotic coverage was done and later, a two stage nephrectomy was done considering the debilitating condition of the patient.     

Primary renal angiosarcoma

Primary renal Angiosarcoma is a rare neoplasm and only 24 cases have been reported in specialized literature. We describe a case of primary renal angiosarcoma in a patient presenting with hematuria, palpable abdominal mass, left flank pain and anemia. A computerized tomography of the abdomen with contrast medium showed a tumor with 15 cm diameter, in the upper pole of the left kidney, with a low-density central area, suggesting necrosis or hemorrhage. Diagnosis was given in a morphologic base and proven by an immunohistochemical study. Primary renal angiosarcoma should be included among differential diagnosis of retroperitoneal hematoma and hemorrhagic renal tumors.     

Xanthogranulomatous pyelonephritis with unconnected liver lesion

Xanthogranulomatous pyelonephritis is a chronic renal inflammation characterized by destruction and replacement of its parenchyma with granulomatous tissue. This uncommon condition is rare in children. We report on a 5-month-old male infant with a left renal and hepatic mass detected by ultrasound. The case was preoperatively misdiagnosed as Wilms' tumor and total nephrectomy and biopsy from liver lesion were performed. The subsequent histopathological findings confirmed the diagnosis of xanthogranulomatous pyelonephritis for renal and liver lesions. Increasing awareness of this disease should lead to the diagnosis being suspected preoperatively even if it is with unconnected tissue lesions.     

Extensive mediastinal lipomatosis in a patient with severe aortic valve stenosis.

Mediastinal lipomatosis is a rare benign condition characterized by a large amount of mature adipose tissue in the mediastinum. We present the case of an 86-year-old male who was admitted to the hospital for analysis of his progressive dyspnea. After careful examination, the patient was diagnosed with severe aortic valve stenosis and extensive mediastinal lipomatosis. This rare coincidence of aortic valve disease and mediastinal lipoma was treated by aortic valve replacement and an extensive debulking procedure.     

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??Diagnosis and treatment of pelvic lipomatosis??A report of 5 patients ZHOU Jia-he, PU Jin-xian, PING Ji-gen. Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou 215000,China
Corresponding author ??PU Jin-xian??E-mail??pjx62@sina.com
Abstract Objective To improve diagnosis and treatment of pelvic lipomatosis in clinical practice. Methods There were 5 male patients with pelvic lipomatosis admitted between February 2009 and March 2012 in the First Affiliated Hospital of Soochow University. They were analyzed in the study with combination of the clinical characteristic, imaging studies, diagnosis and treatment. The clinical characteristics of pelvic lipomatosis were reviewed by combination with the literature. Results Ultrasonography showed bladder deformity and bladder position change, around the neck of bladder had a uniform strong echo and extension of ureters, and also hydronephrosis both side; A typical "vertical buld" shape of bladder, elevated bladder and extended posterior were seen on IVU. CT scan showed there were even distribution of low-density adipose tissues in pelvic cavity and varying degree of compression, deformation, displacement and elevation of bladder, part of the vertex of urinary bladder over the sacrum. Three patients underwent pelvic adipose dissection and uretero-grafting surgery, apparently increased lipid tissue was found in the pelvic cavity and there was large amount of lipid tissue around the bladder and ureters during the surgery. One patient underwent transurethral resection of glandular cystitis and double J ureteral catheter placement on ureteroscopy. One patient was followed up regularly. Postoperative hydronephrosis was relieved gradually. Conclusion B ultrasonography, IVU and CT scan are the most valuable examinations in diagnosis of pelvic lipomatons. Open operation and double J ureteral catheter placement are effective treatments of pelvic lipomatosis. The patient with good kidney function can be performed regular follow-up.     

Epidural lipomatosis and renal transplantation

A 34-year-old man presented with progressive myelopathy 4 months after cadaveric renal transplant for endstage renal disease. Radiographic evaluation gave findings consistent with epidural lipomatosis and compression of the thoracic thecal sac. Decompressive laminectomy resulted in dramatic improvement of his neurologic deficit. This case is unusual in the brevity of steroid treatment prior to onset of the myelopathy, as well as the relatively small dose. The 10 previous cases of epidural lipomatosis are also reviewed.     

Lipomatosis of the bladder presenting as bladder cancer

A case of bladder lipomatosis in an 81-year-old man is presented. The preoperative diagnosis was bladder tumor. A transurethral resection of the bladder was performed and a pathological examination revealed lipomatosis of the bladder. This entity is extremely rare and, to our knowledge, this is the second case reported in the English published works.     

Infantile congenital parotid lipomatosis: a rare case report

A case of congenital parotid lipomatosis in an infant is reported and literature is reviewed. This rare condition in children presents as gradually increasing parotid swelling, which is difficult to diagnose preoperatively as this condition is not considered in the differential diagnosis of a parotid mass. Complete excision with superficial or total parotidectomy with preservation of facial nerve is the treatment of choice.     

Synovial lipomatosis: A rare cause of knee pain in an adolescent female

Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee.     

Angiomyolipoma of the renal sinus: diagnosis by percutaneous biopsy

We report a case of angiomyolipoma of the renal sinus discovered incidentally during an evaluation for microscopic hematuria. Diagnosis was confirmed by percutaneous aspiration biopsy performed with magnetic resonance imaging control allowing differentiation of this entity from other fatty tumors of the renal sinus including liposarcoma, lipoma, and sinus lipomatosis.     

盆腔脂肪增多症诊治分析

目的 提高盆腔脂肪增多症的认识。方法 收治盆腔脂肪增多症1例，男，51岁。影像学主要表现为：IVU示双肾轻度积水，典型倒梨形膀胱、后尿道延长；CT示盆腔内均匀低密度脂肪堆积；MRI示膀胱、直肠周围及盆壁明显增厚的软组织影。采用腹腔镜下清除盆腔及输尿管周围脂肪组织、松解输尿管下段方法治疗。结合 文献复习讨论盆腔脂肪增多症诊治特点。结果术中可见盆腔脏器脂肪组织明显增多，膀胱、直肠及乙状结肠周围充满大量脂肪组织，与影像学表现一致。采用腹腔镜手术剔除盆腔及输尿管周围脂肪加输尿管松解术，剔除脂肪组织约500g，术后病理报告为成熟的脂肪组织。术后1周出院。2周后复查B超示双肾输尿管积水减轻，右肾液性暗区最大直径由术前2．9cm降至2．0cm，右侧输尿管上段扩张直径由1．2cm降至1．0cm，左侧肾积水由1．8cm降至1．3cm，左侧输尿管上段扩张直径由0．8cm降至0．5cm。结论 X线、CT及MRI为此病的主要诊断线索及依据，腹腔镜下剔除盆腔及输尿管周围脂肪加输尿管松解术是治疗此病的有效和微创的方法。     

Diffuse Colonic Lipomatosis,Presenting as Perforation Peritonitis and Mimicking Carcinoma Colon

Lipomas and lipomatosis of colon are rare in clinical practice. We herein report a case of diffuse colonic lipomatosis, fifth such case in literature which presented as perforation peritonitis, a presentation, never been reported earlier. On laparotomy, the findings suggested malignancy and appropriate surgery was done. Diffuse Colonic Lipomatosis, a rare and benign condition mimicks malignancy and should be kept as a differential diagnosis is unusual cases of colonic perforations.     

Symptomatic spinal epidural lipomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases.

Spinal epidural lipomatosis associated with Cushing's syndrome is an uncommon complication (11 reported cases). Two additional symptomatic cases with neurologic deficit are described. Steroid treatment was systemic in the first case and local with epidural injections in the second. The second case is unique because no similar observations have yet been reported. In most cases, a preoperative computed tomographic scan establishes the diagnosis by demonstrating dural compression by an adipose mass. Myelography is far less specific. In some cases, the exact diagnosis is made at the time of surgery. The treatment is primarily surgical, with laminectomy over the length of the compression and the removal of the compressing fat. Neurologic recovery is dependent on two factors: the level of the compression and the adequacy of decompression.