黄色肉芽肿性肾盂肾炎ppt课件

• The clinical presentation of patients :
lumbar(腰痛） and abdominal pain, weight
loss, urinary(泌尿系 ） sy-mptoms,pale
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pathology
• The pathology on macroscopic examination shows usually a kidney yellow, enlarged in size, and with stones inside.
foam（泡沫细胞） cells (arrow up), multinucleated(多核） giant (downward arrow) and mononuclear inflammatory infiltrate.
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Comprehensive imaging manifestation of XGP
central staghorn calculus and hydronephrosis. The renal parenchyma is replaced by multiple
confluent fluid-filled masses).
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Fra Baidu bibliotek
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imaging manifestation of XGP
• It is almost always unilateral(单侧）.
• It occurs in 1% of a-ll renal infections. 2
• The exact etiology of XGP is unknown, but it is generally accepted that the disease process requires long-term renal obstruction (障碍）and infection. Stones may occur in 75% of patients with XGP but are not required to make the diagnosis.
A 44-year-old woman who reported urinary symptoms for the past 6 months.
Computed tomography was typical for diffuse XGP: enlarged left kidney with a voluminous(大量）
histiocytes sparkling grouped and contained lipids, which are called xanthoma（黄色瘤） cells that are associated with a diffuse inflammatory infiltrates, where cells are round, the plasmocytes（浆细胞）.
Diffuse XGP in an 87-year-old man. A post-contrast enhanced CT image
demonstrates diffuse enlargement of the left kidney with massive pelvic
dilatation and major caliectasis.
imaging manifestation of XGP
Focal XGP in a 54-year-old woman. A post-contrast enhanced CT image demonstrates a functioning left kidney occupied by an ovoid（卵形） exophytic （外生性）mass with necrotic loculations（小腔） and thick walls. Although this is focal XGP, extension of the inflammatory process to the posterior （后方- ）pararenal space was noted, with loc9al thickening of Gerota‘s fascia（吉氏筋膜）.
Macroscopic view of the inside of a surgical specimen of a
kidney with XP. Presence of multiple cystic cavities.
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Microscopic examination macrophages are loaded with fat (histiocytes sparkling（闪闪发光的）), explaining his color, in addition to necrosis and infiltration（渗出物） with leukocytes and plasmatic cells
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imaging manifestation of XGP
A 37-year-old woman presented with low back pain and a fever. A post-contrast enhanced CT image demonstrates an enlarged left kidney with hydropyonephrosis （肾盂积脓）， a multilocular intraparenchymatous pseudocyst（多房性的肾实质假囊肿）, inflammatory infiltration（渗出） of the perirenal （-肾周）fat, and a thick-walled abscess in the8 adjacent（邻近的） muscle.
Xanthogranulomatous pyelonephritis
黄色肉芽肿性肾盂肾炎
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Introduction
• Xanthogranulomatous pyelonephritis (XGP) is an unusual form of chronic pyelonephritis in which the renal parenchyma（肾实质） is destroyed and replaced by lipid-laden foamy macrophages（充满脂质的巨噬细胞）.