Renal replacement lipomatosis: A rare type of renal pseudotumor

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Abstract

Replacement lipomatosis of the kidney is the end result of severe atrophy of renal parenchyma with secondary marked proliferation of renal sinus and perirenal fatty tissue. Although ultrasonography may suggest the diagnosis, CT demonstrated the distinctive features most accurately. We report a case of renal replacement lipomatosis with coexistent xanthogranulomatous pyelonephritis and multiple perinephric and parietal wall collections.

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Most cited references 10

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The renal sinus: pathologic spectrum and multimodality imaging approach.

Hyeok Lee, J Byun, Yuh-S Jung … (2004)

Various pathologic conditions can occur in the renal sinus, primarily originating in the constituents of the renal sinus, and the renal sinus can be secondarily involved by surrounding renal parenchymal and adjacent retroperitoneal lesions. Lipomatosis and cysts are common renal sinus lesions with little clinical significance, but differentiation from other pathologic conditions is important. Renal vascular lesions such as renal artery aneurysm or arteriovenous fistula can mimic other parapelvic or peripelvic lesions at excretory urography, but their vascular nature is evident at color Doppler ultrasonography, contrast material-enhanced computed tomography (CT), and magnetic resonance (MR) imaging. Although most tumors originating in the renal pelvis are transitional cell carcinoma or squamous cell carcinoma, renal parenchymal tumors such as renal cell carcinoma or benign multilocular cystic nephroma have a tendency to grow into the renal sinus. Rare tumors of mesenchymal origin can develop in the renal sinus, but their imaging findings are nonspecific. The observation of renal sinus fat is important for detecting a small tumor located in that area and determining the exact tumor stage. Multiplanar CT or MR images can allow exact evaluation of the extent of complex renal sinus disease. Copyright RSNA, 2004.

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CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation.

J P Finizio, E Fishman, Barry S. Goldman … (1984)

A clinical-radiologic-pathologic correlation study was performed in 18 (17 female) patients with xanthogranulomatous pyelonephritis (XGP) with CT scans available for analysis. Presenting signs and symptoms included pain (66%), urinary frequency (66%), dysuria (66%), nocturia (66%), palpable mass (56%), leukocytosis (50%), and fever (50%). The duration of symptoms was usually relatively short (less than 6 months), considering the extent of the pathologic process. In 14 patients, the disease was diffuse; the kidney was enlarged with preservation of the reniform outline in 13. The renal pelvis, lined with sheets of lipid-laden macrophages and surrounded by a marked fibrotic reaction, was contracted in 11 and contained pelvic calculi in 12. The parenchyma was replaced by multiple, rounded, low-density areas on CT that corresponded to dilated calices and/or inflammatory tissue. These areas had enhancing rims (10 cases) that corresponded to preserved, compressed normal parenchyma and/or inflammatory tissue. There was CT identification of unsuspected extension through the renal capsule with involvement of the perirenal space in 11 patients, the pararenal spaces in 13, and the psoas muscle in six. The pararenal space and the psoas muscle were often extensively involved with minimal perirenal disease in six patients, a reflection of chronic indolent infection. There were four cases of focal XGP that appeared on CT as low-density mass lesions with wall enhancement surrounding dilated, stone-filled calices or as focal masses occupying one pole of a duplication. Extensive pararenal disease was present in two of the four cases of focal XGP. The preoperative diagnosis of XGP was suspected in only 44% of cases. It is concluded that CT should play a role in diagnosis and preoperative planning to demonstrate the extent of extrarenal disease that is poorly depicted by other means.

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Case report: Renal replacement lipomatosis associated with renal transplantation.

Thalia R. Goldstein, S. Chang, F Coakley (2004)

We report a case of extensive renal replacement lipomatosis demonstrated by ultrasound (US) and computed tomography (CT) in a 57-year-old woman with a history of two cadaveric renal transplants. One transplant was non-functional due to chronic rejection. The second renal transplant is functioning normally and the renal replacement lipomatosis did not cause mass effect on either of the renal transplants.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Nephrol

Journal ID (publisher-id): IJN

Title: Indian Journal of Nephrology

Publisher: Medknow Publications (India )

ISSN (Print): 0971-4065

ISSN (Electronic): 1998-3662

Publication date (Print): April 2010

Volume: 20

Issue: 2

Pages: 92-93

Affiliations

Department of Radiodiagnosis, SMHS Hospital, Soura, India

[1 ]Department of Pediatrics, Sher-i-Kashmir of Institute of Medical Sciences, Soura, India

Author notes

Address for correspondence: Dr. N. Choh, Cooperative Colony, Pirbagh, Srinagar, India. E-mail: naseerchoh@ 123456rediffmail.com

Article

Publisher ID: IJN-20-92

DOI: 10.4103/0971-4065.65303

PMC ID: 2931141

PubMed ID: 20835324

SO-VID: 9d2c0a6f-c484-4a8a-b6e9-edb596ca6d6a

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Renal replacement lipomatosis: A rare type of renal pseudotumor

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Karger: Nephrology

Most cited references 10

The renal sinus: pathologic spectrum and multimodality imaging approach.

CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation.

Case report: Renal replacement lipomatosis associated with renal transplantation.

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