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  #1  
Old 03-02-2012
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Default Flank tenderness

A 52-year-old woman comes to the physician
because of a 2-day history of fever and left flank
pain. She has been treated for multiple episodes
of pyelonephritis during the past 3 years. Her
temperature is 37.8C (100.1F). Physical
examination shows left flank tenderness.
Urinalysis shows 12
18 WBC/hpf with
occasional lymphocytes and mononuclear cells
with features of macrophages. Cultures of urine
grow 80,000 colonies/mL of
Proteus mirabilis.
An x-ray of the abdomen shows a 3-cm mass in
the lower pole of the left kidney. Gross
examination of the mass after it has been
resected shows that it is yellow, 3.2-cm in
diameter, and centrally but not marginally
necrotic. Histologic examination of the mass
shows a predominance of epithelioid cells with
partially clear and granular-to-foamy cytoplasm.
Nuclei are eccentric, normochromic, symmetric,
and without significant pleomorphism. Scattered
lymphocytes and plasma cells are intermixed.
Which of the following is the most likely
diagnosis?
(A) Acute pyelonephritis
(B) Malacoplakia
(C) Renal cell carcinoma, clear cell type,
intermediate grade
(D) Renal cell carcinoma, granular cell type

(E) Xanthogranulomatous pyelonephritis
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  #2  
Old 03-02-2012
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Default

Ans .............E............
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  #3  
Old 03-02-2012
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can you explain.
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  #4  
Old 03-02-2012
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Quote:
Originally Posted by jinni View Post
A 52-year-old woman comes to the physician
because of a 2-day history of fever and left flank
pain. She has been treated for multiple episodes
of pyelonephritis during the past 3 years. Her
temperature is 37.8C (100.1F). Physical
examination shows left flank tenderness.
Urinalysis shows 12
18 WBC/hpf with
occasional lymphocytes and mononuclear cells
with features of macrophages. Cultures of urine
grow 80,000 colonies/mL of
Proteus mirabilis.
An x-ray of the abdomen shows a 3-cm mass in
the lower pole of the left kidney. Gross
examination of the mass after it has been
resected shows that it is yellow, 3.2-cm in
diameter, and centrally but not marginally
necrotic
. Histologic examination of the mass
shows a predominance of epithelioid cells with
partially clear and granular-to-foamy cytoplasm.
Nuclei are eccentric, normochromic, symmetric,
and without significant pleomorphism. Scattered
lymphocytes and plasma cells are intermixed.
Which of the following is the most likely
diagnosis?

(E) Xanthogranulomatous pyelonephritis

from the above clues you know its pyelonephritis and a mass which is yellow = xantho ...... epitheliod cells , central necrosis = granulomas ......

so E ........
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  #5  
Old 03-02-2012
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either A or E...?
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  #6  
Old 03-02-2012
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Quote:
Originally Posted by Hitman View Post
from the above clues you know its pyelonephritis and a mass which is yellow = xantho ...... epitheliod cells , central necrosis = granulomas ......

so E ........
ahh so simple, yet so difficult.
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  #7  
Old 03-02-2012
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ans is E
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