HISTORY:
80yr old/ female
History of pyelonephritis, left staghorn calculus, hydronephrosis with left nephrostomy tube placement
GROSS:
Zonal structure may be visible:
- Inner zone: dilated pelvicalyceal system with necrotic debris.
- Middle zone: granulation tissues surrounded by lipid laden macrophages (xanthoma cells) giving a yellow-orange appearance.
- Outer zone: fibrosis may extend into renal fat capsule and beyond; decapsulation of kidney may not be feasible.
What is the most likely diagnosis?
- Malakoplakia
- Renal tuberculosis
- Renal replacement lipomatosis
- Xanthogranulomatous pyelonephritis
- Clear cell renal cell carcinoma
Xanthogranulomatous pyelonephritisÂ