Xanthogranulomatous pyelonephritis with associated renal cell carcinoma

Area of Science:

• Nephrology
• Oncology
• Radiology

Background:

• Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic bacterial infection of the kidney, often associated with obstruction, calculi, and infection.
• Computed tomography (CT) is crucial for diagnosing XGP, but its imaging findings can overlap with other renal pathologies, notably renal cell carcinoma (RCC).

Observation:

• This case highlights the rare but significant association of XGP with concomitant renal cell carcinoma.
• The diagnostic challenge lies in differentiating XGP from RCC based solely on imaging, as their appearances can be similar.

Findings:

• Nephrectomy is the traditional treatment for XGP, though conservative antibiotic therapy has been explored post-tissue diagnosis.
• Conservative management of biopsy or cytology-proven XGP carries a risk of missing synchronous malignant tumors, such as RCC.

Implications:

• The potential for co-existing renal cell carcinoma necessitates caution with conservative management strategies for xanthogranulomatous pyelonephritis.
• Surgical intervention, such as nephrectomy, remains the recommended approach for XGP, particularly in patients who are surgical candidates, to ensure complete tumor resection.