1996 XGP Antibiotics - Xanthogranulomatous pyelonephritis

====== 1996 XGP Antibiotics ======

http://www.ncbi.nlm.nih.gov/pubmed/8838188

Clin Infect Dis. 1996 Feb;22(2):308-14.
Xanthogranulomatous pyelonephritis: report of nonsurgical management of a case and review of the literature.

Brown PS Jr, Dodson M, Weintrub PS. University of Colorado Health Sciences Center, Denver, USA.

Abstract

A case of focal xanthogranulomatous pyelonephritis (XPN) in a child, successfully cured with antibiotics only, is presented, and this report is followed by a review of the literature on XPN in both children and adults. XPN is a rare inflammatory disease of the kidney. Factors strongly implicated in the development of XPN are genitourinary obstruction and urinary tract infection, although other contributing factors have been suggested. The clinical presentation of the disease is remarkably nonspecific and variable; it therefore is frequently misdiagnosed as other, more common diseases that cause focal or diffuse renal masses, including renal neoplasms, abscesses, and tuberculosis. Diagnosis requires acquisition of renal tissue for special pathological staining. The long-standing mainstay of therapy for XPN has been nephrectomy or partial nephrectomy. However, this report and other recent reports of the successful medical management of focal XPN suggest that a trial of antibiotics prior to surgery is warranted in cases of focal XPN.

FULL TEXT http://cid.oxfordjournals.org/content/22/2/308.1.full.pdf#page=1&view=FitH

====== TUNESIA ======
http://www.ncbi.nlm.nih.gov/pubmed/19472811
Tunis Med. 2008 Oct;86(10):912-5.
Focal xanthogranulomatous pyelonephritis: success of conservative treatment. A case report.

Fitouri Z, Nouira Y, Nouira K, Sallami S, Hmidi M, El Fekih N, Horchani A.

Department of Urology, La Rabta hospital, Tunis, Tunisia.
Abstract

BACKGROUND: Focal xanthogranulomatous pyelonephritis is an atypical form of chronic renal infection. It is frequently misdiagnosed preoperatively because of its resemblance to malignancy.

CASE REPORT: We report on a fifty-year-old woman who presented with a right kidney mass. The CT scan showed a solid renal mass with a lithiasis of the upper ureter. The diagnosis of focal xanthogranulomatous pyelonephritis was suspected by clinical and radiological findings and confirmed by histopathologic examination of percutaneous biopsy specimens of the lesion. Successful treatement of the patient was achieved with removal of the lithiasis and antibiotic therapy during eight weeks. Three months later the CT scan was completely normal.

CONCLUSION: The conservative treatment of focal xanthogranulomatous pyelonephritis makes possible to avoid a needless nephrectomy usually on young patients. However a close follow-up must be undergone on these patients because of the possible association of focal xanthogranulomatous pyelonephritis and renal cell carcinoma of the kidney.

PMID: 19472811 [PubMed - indexed for MEDLINE]

========== GRENOBLE 1995 ANTIBIOTICS =====

Eur Urol. 1995;27(2):170-3.
Pseudoneoplastic xanthogranulomatous pyelonephritis. A typical clinical presentation but unusual diagnosis and treatment.

Mollier S, Descotes JL, Pasquier D, Coquillat P, Michel A, Dalsoglio S, Rambeaud JJ.

Service d'urologie et de transplantation, Centre hospitalier régional et universitaire, Grenoble, France.

Abstract

Xanthogranulomatous pyelonephritis is a rare disease that may mimic various renal lesions, especially renal tumors, in its focal form. We report a case of pseudoneoplastic xanthogranulomatous pyelonephritis in a young woman. This case is unusual, because it was diagnosed by a percutaneous renal puncture and furthermore total renal recovery was achieved by antibiotic treatment alone.

========= LIEGE 2001 =====================

Prog Urol. 2001 Dec;11(6):1274-6.
[Pseudotumoral xanthogranulomatous pyelonephritis: diagnosis with percutaneous biopsy and success of conservative treatment].

[Article in French]

Reul O, Waltregny D, Boverie J, de Leval J, Andrianne R.

Service d'Urologie, Centre Hospitalier Universitaire du Sart-Tilman, Liège, Belgique. olivierreul@hotmail.com

Abstract

Focal xanthogranulomatous pyelonephritis is an unusual form of chronic renal infection that is difficult to diagnose prior to surgery. We report on a 19-year-old woman who presented with a renal mass that mimicked malignancy. The diagnosis of focal xanthogranulomatous pyelonephritis was first suspected by radiological findings and further confirmed by histopathologic examination of percutaneous biopsy specimens of the lesion. Successful treatment of the patient was achieved with antibiotic therapy alone. Maximal efforts, including percutaneous renal biopsy, should be made to establish the diagnosis of focal xanthogranulomatous pyelonephritis before a therapeutic decision is reached. We recommend the use of antibiotics as a first-line treatment for patients with focal xanthogranulomatous pyelonephritis.


XGP is often misdiagnosed preoperatively.
http://bestpractice.bmj.com/best-practice/monograph/552/diagnosis/step-by-step.html

http://lib.bioinfo.pl/paper:11486322
Sonographic features of xanthogranulomatous pyelonephritis.

http://www.ncbi.nlm.nih.gov/pubmed/20544282
Xanthogranulomatous pyelonephritis: critical analysis of 30 patients.


==== EVEN IN PANCREATIC CANCER there is MIMICKING =====

Xanthogranulomatous lesion of the pancreas mimicking pancreatic cancer.
Yukihiro Iso, Nobumi Tagaya, ... Keiichi Kubota
We reported a rare case of XGP mimicking pancreatic cancer. XGP should be added to one of differential diagnosis of pancreatic cance...

BACKGROUND: Xanthogranulomatous lesion is a rare condition that can develop in the gall bladder, kidney, and retroperitoneal space. This lesion is an inflammatory disease. It is commonly accepted that Xanthogranulomatous lesion of the pancreas (XGP) is hardly distinguishable from pancreatic neoplasms. As a result of the similarity of pancreatic cancer in clinical and imaging diagnostic findings, most of all patients have often been performed excessive surgeries. CASE REPORT: An 82-year-old male was admitted to our hospital because of body weight loss. Laboratory tests showed the presence of inflammation, and a Positron emission tomography (PET) revealed positive uptake in the pancreas head and tail, and spleen. Duodeno scopy showed excretion of mucin from the papilla of Vater. Intraductal ultrasonography (IOUS) showed a tumor located at the pancreas tail. Under a preoperative diagnosis of intraductal papillary mucinous carcinoma (IPMC) at the pancreas tail with metastasis to the spleen, distal pancreatectomy and splenectomy were performed. Microscopic findings of the operative specimen revealed massive infiltration of macrophages with fibrosis, the lost of ductal epithelium, and the severe deposition of amyloid and mucin with thrombosis. Pathological diagnosis was XGP. The patient was uneventfully discharged from hospital on the postoperative day 22. Although XGP is a benign condition, most cases are treated by surgery same as our case. This is due to the difficulty in differenciating the lesion from pancreatic cancer. CONCLUSIONS: We reported a rare case of XGP mimicking pancreatic cancer. XGP should be added to one of differential diagnosis of pancreatic cancer.