A 45-year-old male with history of recurrent ureteric calculi presented with fever. Right-sided nephrectomy was performed. Gross view and histology have been provided. What is your diagnosis?
Ans. a. Chronic pyelonephritis with hydronephrosis (Ref: Robbins 9/e p933-935, 8/e p943-961)In a 45-year old male with history of recurrent ureteric calculi, who presented with fever: Right-sided nephrectomy was performed. Grossly kidney shows hydronephrosis with evidence of scarring. Microscopically changes predominantly involve tubules and interstitium. Most probable diagnosis would be Chronic pyelonephritis with hydronephrosis.Chronic Pyelonephritis* Insidious in onset, may present with clinical manifestations of acute recurrent pyelonephritis with back pain, fever, frequent pyuria, and bacteriuria.* Gross examination: Irregularly scarred kidney; if bilateral, the involvement is asymmetric.* Hallmark of chronic pyelonephritis: Coarse, discrete, corticomedullary scar overlying a dilated, blunted, or deformed calyx.* Most of the scars are in the upper and lower poles, consistent with the frequency of reflux in these sites.* Microscopic changes: Predominantly involve tubules and interstitium.* Dilated tubules with flattened epithelium may be Ailed with colloid casts (thyroidization).* Glomeruli may appear normal except for periglomerular fibrosis, but a variety of glomerular changes may be present, including ischemic fibrous obliteration as well as secondary changes related to hypertension.Adult Polycystic Kidney Disease* Gross Appearance: Kidneys are usually bilaterally enlarged and may achieve enormous sizes.* The external surface appears to be composed solely of a mass of cysts, up to 3 to 4 cm in diameter, with no intervening parenchyma.* Microscopic examination reveals functioning nephrons dispersed between the cysts.* The cysts may be filled with a clear, serous fluid or, more usually, with turbid, red to brown, sometimes hemorrhagic fluid.Renal Cell Carcinoma* Usually presents as a yellowish, spherical mass in one pole of the kidney.* In clear cell carcinoma, the growth pattern varies from solid to trabecular (cordlike) or tubular (resembling tubules). The tumor cells have a rounded or polygonal shape and abundant clear or granular cytoplasm; the latter on special stains contains glycogen and lipids.* Papillary carcinoma is composed of cuboidal or low columnar cells arranged in papillary formations. Psammoma bodies may be present. The stroma is usually scanty but highly vascularized.* Chromophobe renal carcinoma is made up of pale eosinophilic ceils, often with a perinuclear halo, arranged in solid sheets with a concentration of the largest cells around blood vessels.* Collecting duct carcinoma is a rare variant showing irregular channels lined by highly atypical epithelium with a hobnail pattern.* Sarcomatoid changes arise infrequently in all types of renal cell carcinoma and are a decidedly ominous feature of these tumors.Cystic Dysplastic Kidney* Dysplasia can be unilateral or bilateral and is almost always cystic.* Gross appearance: Kidney is usually enlarged, extremely irregular, and multicystic.* The cysts vary in size from microscopic structures to some that are several centimeters in diameter.* The characteristic histologic feature is the presence of islands of undifferentiated mesenchyme, often with cartilage, and immature collecting ducts.
Chronic pyelonephritis with hydronephrosis
Renal cell carcinoma
Autosomal dominant polycystic kidney disease
Cystic dyspiastie kidney
Miscellaneous (Kidney & Uterus)