本邦最初のXanthogranulomatous Pyelonephritis (Foam Cell Granuloma)

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There has been a recent increase in the number of reported cases of xanthogranulomatous pyelonephritis. Two cases of the disease, the first reported cases in Japan, which have mimiced tuberculous pyonephrosis and/or hypernephroma, are reported. Case 1. 50 years old. Housewife. Patient was seen in our outpatient department on March 30, 1961. History dates back to her age of eighteen when she was treated as tuberculous pleuroperitonitis. At the age of 45, she had an episode of a severe pain on the left lower back associated with nausea and vomiting. No particular bladder-symptom was present, but hematuria was detected. Within 30 days following the above episode, she had attack of same nature on three different occasions. Possibility of urolithiasis was pointed out by a surgeon, and chromocystoscopy was performed with the result of delayed excretion of dye from the left ureter. No further examination was done, because of the spontaneous disappearance of the symptoms. In January, 1961, she had the same spell associated with high fever. With a provisional diagnosis of acute pyelitis, immediate treatment was started. The high fever was somehow suppressed down to 37℃, but symptoms characterized by fullness and tenderness on the left lower back and lower abdomen remained unchanged for a considerable period. Hematological examination showed no abnormality, but a mild degree of anemia. Series of urinalysis presented occasional cloudiness from which many pus-cells and E. coli were detected. Chromocytoscopy clearly unveiled that the left ureteral orifice had no contraction and no dye was excreted from this side. Left kidney presented itself as a huge sensitive mass on palpation. A plain x-ray film revealed the kidney as a dim shadow. Intravenous pyelography showed complete absence of the left renal pelvis and mild hydronephrosis on the right side. The past history of the tuberculous pleuroperitonitis led to the tentative diagnosis of "Tuberculous obstructive pyonephrosis" and left nephrectomy was performed on April 14. On operation, the renal capsule was highly thickned and fibrolipomatous proliferation of the perirenal tissue was prominent. In some parts of this perirenal tissue, there were noticed markedly engorged veins. Surgical manipulation was difficult, because of the extensive adhesion between the peritoneum and the kidney. There was no gross abnormality on the ureter. The removed Kidney measured 19×10.5×8 cm and weighed 790 gm containing 540 gm of cream like pus. The cut-surface revealed a large renal pelvis with cavernous destruction of all calyces. Parenchyma itself fell into fibroid degeneration throughout and there was a belt of yellowish granulomatous tissue adjacent to the calyceal cavity wall. The ureteropelvic junction was virtually obstructed. The culture of the pus was positive for E. coli, while it was negative for TB. Histological findings: H.E. stainig reveled no trace of tuberculosis, but banal chronic inflammation. The wall of the cavity was infiltrated by numerous inflammatory cells together with so called "clear cells". While a part of the clear cell mass forming papillary proliferation, protrudes into the pelvis, the greater part proliferates infiltratively or groupwise into the parenchyma showing an extremely resembled picture to hypernephroma originated from the plevis and calyces. By fat-stainig and silver-stainig method, these cells were identified as "form cells". This was the case diagnosed as obstructive renal tuberculosis preoperatively, and was treated accordingly, with 17 gms of streptomycin.
社団法人日本泌尿器科学会の論文

本邦最初のXanthogranulomatous Pyelonephritis (Foam Cell Granuloma)

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