Renal malakoplakia as a pseudotumoral lesion in a renal transplant patient: A case report

Malakoplakia is a rare chronic inflammatory disease associated with gram-negative bacterial infections frequently caused by Escherichia coli. Malakoplakia usually affects the lower urinary tract (bladder) but there are cases described in the kidney as well as in the respiratory and digestive organs. We report on a case with renal parenchymal malakoplakia in a renal transplant patient and describe the pathological lesions of malakoplakia: histiocytic proliferation with scarce inflammatory infiltrate, histiocytes with acidophilic cytoplasm and the presence of characteristic Michaelis-Gutmann bodies. The authors in this study review the updated reports related to the entity in this uncommon localization, the association with an immunocompromised patient, the macroscopic presentation as a pseudotumoral lesion and the possible relationship with the xanthogranulomatous pyelonephritis as a form of a histopathological spectrum in patients affected with gram negative urinary tract infection.     

Meningeal tuberculosis and renal lithiasis. A case report

Urinary tuberculosis is frequent in Algeria. The discovery of the disease become difficult when one of the three criterium of the diagnostic does not allow a diagnosis of certitude. The authors reported the case of a 44 years-old patient admitted to hospital for tuberculous meningitis recovery from left nephrectomy for urinary lithiasis. The histology does not find specific lesions. Then, no antituberculous treatment is prescribed. The patient has developed renal and meningitis tuberculosis associated with urinary lithiasis. Koch's bacillus is found in the urine. The evolution under medical treatment was excellent. The urinary lithiasis has hided tuberculosis and the discovery of the disease was late.     

Complex renal cyst. A new case

Approximately 15% of cases of renal cell carcinoma present cystic configuration on radiologic and pathologic examination. These lesions are often difficult to differentiate from the multiloculated renal cyst or other benign cystic lesions such as hemorrhagic cyst and so on. We report a case of multilocular cyst of the right kidney complicated with clear cell type renal cell carcinoma in which MRI suggested benign cyst. The diagnosis of complicated benign cyst must be proposed very cautiously and the persistence of doubtful images justifies surgical exploration.     

A case of renal tuberculosis following bacillus Calmette-Guerin instillation therapy for bladder cancer

A rare case of histopathologically revealed renal tuberculosis caused by intravesical bacillus Calmette-Guerin (BCG) therapy is reported. A 67-year-old man was admitted complaining of fever and micturition pain. He had been undergoing prophylactic BCG instillation therapy for recurrent superficial bladder tumor. Physical examination was unremarkable. The tuberculin skin test was negative. Mycobacterium tuberculosis (MT) was not demonstrated by acid-fast staining and culture of urine. However, MT was isolated by the polymerase chain reaction method. In the following 7 days, symptoms were dissolved with administration of isoniazid, rifampicin and piperacillin. Two months later, nephroureterectomy was performed because of left renal pelvic tumor. Tuberculomas were also found in the renal parenchyma which showed no MT by Ziehl-Neelsen's method. Anti-tuberculous medication was not given postoperatively. Two months after operation, he is free of disease with normal urine examination and positive tuberculin skin test measuring 12 x 10 mm.     

A case of urinary and miliary tuberculosis detected during examination for renal failure

A case of urinary and miliary tuberculosis in a 51-year-old male is reported. The patient with the complaint of low grade fever at night and appetite loss had visited another clinic. Laboratory data showed renal failure (serum creatinine 3.9 mg/dl, BUN 35.1 mg/dl) and he was referred to our hospital. Ultrasonography and computed tomography (CT) revealed bilateral hydronephrosis. Therefore we suspected postrenal renal failure. We performed cystoscopy in order to perform retrograde pyelography and to indwell double J stent. The bladder showed yellow-whitish nodules all over the bladder. Tuberculous bacilli were detected in the urine by smear, polymerase chain reaction (PCR) and culture. Chest radiography and CT revealed multiple granular nodules and so diagnosed miliary tuberculosis. Immediately combination chemotherapy of with isonicotinic acid hydrozide, rifapicin, ethanbutal and pirazinamide was administered. Histopathology by bladder biopsy showed epithelioid cell granuloma. Chemotherapy was effective, but the vesical capacity was contracted to less than 50 ml, and we suspect that the patient will need vesical augmentation.     

腓肠肌结核1例

患者,男,55岁。因发现右小腿包块半年,于2009年5月11日入院。患者于入院前半年无意间发现右小腿外侧中段有一约鸡蛋大小包块,活动时疼痛,在门诊多次给予治疗,症状缓解不明显。患者既往体健,无咳嗽、咳痰,乏力、盗汗等结核病症状。查体：一般状态良好,无结核中毒症状,体温：36．6℃。右小腿外侧明显肿胀,中段可触及一约7cm×6cm大小包块,与周围组织边界欠清,活动度差,质硬．压痛。     

Autopsy case of miliary tuberculosis with cerebral involvement in renal failure

We encountered an autopsy case of renal failure complicated by cerebral tuberculosis. The patient was hospitalized due to disturbance of consciousness, and dialysis therapy was performed because of end-stage renal failure. Approximately 1 week later, abnormal shadows were observed on chest X-ray, and various examinations were performed until the diagnosis was finally determined as miliary tuberculosis. Disturbance of consciousness was exacerbated, despite the administration of antituberculosis drugs and other treatments, and the patient died on the 105th hospital day. Pathological examinations demonstrated miliary tuberculosis associated with intracranial involvement, in addition to contracted kidneys. In patients with end-stage renal failure, the risk of developing tuberculosis, miliary tuberculosis in particular, is reported to be much higher than in normal subjects. However, the diagnosis of miliary tuberculosis is difficult to establish, because of nonspecific symptoms and the low rate of detection of acid-fast bacteria from the sputum. Comprehensive understanding of the results of frequent culture examinations of sputum and blood, contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), and Polymerase chain reaction (PCR) of cerebrospinal fluid, as well as albumin concentration in the cerebrospinal fluid, are considered useful in diagnosing intracranial tuberculosis. Although cerebral tuberculoma is rare, prolonged disturbance of consciousness may be related to cerebral tuberculosis. Therefore, particular attention should be paid to patients with end-stage renal failure complicated by disturbance of consciousness. Received: October 9, 1998 / Accepted: February 23, 1999     

胸锁关节结核1例

1病例资料患者,女,50岁,左胸锁关节有黄豆粒大小肿物,无疼痛,未行任何处理。约1个月后,感左胸锁关节处肿物疼痛,就诊当地医院进行治疗,诊断未明确,患者症状无缓解,未继续治疗。肿物进行性增大、疼痛加重1个月,遂就诊于我院。无潮热、盗汗等症状。查体:左胸锁关节处可触及一1·5     

A case of spermatic cord tuberculosis

A 47-year-old man visited our hospital with a complaint of a right intrascrotal mass. The results of a laboratory examination were unremarkable. An ultrasonographic examination of the right scrotum demonstrated a low echoic legion, 2.5 x 1.3 x 0.7 cm in diameter. A right spermatic cord tumor was diagnosed. Right high orchiectomy was performed. Microscopic examination showed a granulomatous lesion with Langhans large cells. Tuberculin skin test was strongly positive. From these findings we diagnosed the patient with tuberculosis in the spermatic cord.     

A case of renal pseudotumor

A case of renal pseudotumor in a 47-year old female is reported. She was admitted with the complaint of right flank pain. Intravenous pyelography showed filling defect in right renal pelvis and spreading deformity of calices with compression of infundibuli. Ultrasonography and computed tomography demonstrated round renal mass. Since possibility of hypovascular tumor was not completely ruled out by right selective renal angiography, subsequently performed, then right nephrectomy was done. Bisected specimen revealed mal position of renal lobe (lobar dysmorphism). Microscopic appearance showed normal renal parenchyma. The literature is also reviewed.     

A case of renal oncocytoma

A case of renal oncocytoma is reported. A 56-year-old woman was admitted with the complaint of an abdominal mass. Right transabdominal nephrectomy was performed on January 23, 1984. The resected kidney weighed 262 g and contained a well-demarcated 5 X 5 X 4 cm tumor in the middle portion. The cross section of the tumor was tan-brown. Light microscopic examination disclosed that the greater part of the tumor was composed of cells with abundant, and finely granular eosinophilic cytoplasm and with moderate nuclear pleomorphism. Electron microscopic examination confirmed that the cytoplasm had numerous mitochondria and few other organelles. According to these findings, the tumor was diagnosed as renal oncocytoma. Furthermore, it is noteworthy that in this case there were tubular arrangement of the cells resembling proximal renal tubules in a focal area and a group of cells with considerable nuclear atypia and hyperchromatism in another area. The patient has been well without any local recurrence or distant metastasis ten months after the operation. In addition, fourteen cases of renal oncocytoma in Japan, including the present case, are reviewed.     

A case of renal leiomyoma

A case of renal leiomyoma in a 35-year-old female is presented. Since 1948, fifteen cases including our own case of renal leiomyoma, have been reported in the Japanese literature. They were discovered either from clinical symptoms or incidentally by on image diagnostic study. Some diagnostic and therapeutic problems are discussed.     

A case of renal schwannoma

A case of renal schwannoma is presented. A 51-year-old female was admitted to our hospital because of a left renal mass on April, 16, 1987. A drip infusion pyelogram showed encasement of the lower and medial calyx. An abdominal CT-scan showed a 2.5 cm mass with irregular density. Selective left renal arteriography showed the hypovascular tumor of the left kidney. Transperitoneal radical nephrectomy was performed on May, 1, 1987. Histological diagnosis was renal schwannoma arising from renal pelvis. The patient was well without recurrence 20 months after operation. Our present case is the 12th case of renal schwannoma reported in the English and Japanese literature.     

A case of renal actinomycosis

A case of renal actinomycosis is reported. A 63-year-old man was admitted to our hospital for further examinations of a right renal mass, complaining of dull pain in his right loin and progressive weight loss. Laboratory findings showed an anemia with a grossly raised ESR, CT, MRI and ultrasonography revealed a solid mass of the right kidney. Chest CT films revealed several infiltrates in the bilateral lobes. A diagnosis of neoplasm or inflammatory mass of the right kidney was considered, and the right nephrectomy was performed. Microscopically, characteristic colonies of actinomyces were seen, and histological diagnosis was renal actinomycosis. The patient made good progress after operation and was subsequently treated with penicillin.