Xanthogranulomatous pyelonephritis (gross pathology)

Case contributed by A.Prof Frank Gaillard

Patient Data

Age: 40 years
Gender: Male

Nephrectomy specimen

MACROSCOPIC DESCRIPTION: Sectioning of the kidney reveals a lesion at the superior pole, 33x18x18mm, with a soft, mottled, tan, focally cystic cut surface.  It is well delineated from the adjacent renal parenchyma and expands but does not infiltrate the overlying capsule, from which it is readily dissected.  The lesion shows no invasion into the renal pelvic fat.  No other tumor or lymph nodes are identified.

MICROSCOPIC DESCRIPTION: Sections of the kidney show features of xanthogranulomatous pyelonephritis.  The area is relatively ill-defined.  There are many foamy and pigment-laden macrophages with lymphocytes and plasma cells. Spindled reactive fibroblasts are seen and they form vague short fascicles, intermixed with the inflammatory cells.  There is no evidence to suggest malakoplakia.  The inflammation extends into the interstitium.  Acute inflammation is inconspicuous.  There are no granulomas.  No evidence of necrosis is seen.  The glomeruli adjacent to the inflammatory areas are globally sclerosed.  No tumor is identified.  There are a few cystic locules, which are lined by flattened-to-cuboidal epithelium with no atypia.  Occasional cholesterol clefts are identified, surrounded by multinucleated giant cells.  The remaining renal parenchyma is unremarkable. 

FINAL DIAGNOSIS: Xanthogranulomatous pyelonephritis.

Case Discussion

Macroscopic appearance of kidney - subsequent histological examination confirmed xanthogranulomatous pyelonephritis.

Gross pathology image courtesy of Dr Alpha.Tsui, Royal Melbourne Hospital.

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Case information

rID: 16888
Published: 27th Feb 2012
Last edited: 13th Aug 2019
System: Urogenital
Tag: kidney
Inclusion in quiz mode: Excluded

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