课件：黄色肉芽肿性肾盂肾炎.ppt

Xanthogranulomatous pyelonephritis 黄色肉芽肿性肾盂肾炎 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）. It is almost always unilateral(单侧）. It occurs in 1% of all renal infections. XGP is 4 times more common in females than in men and is usually noted in the fifth and sixth decades of life. 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. The clinical presentation of patients : lumbar(腰痛） and abdominal pain, weight loss, ?urinary(泌尿系 ） symptoms,pale conjunctiva（结膜）, kidney stones and chronic evolution of the disease. High fever and palpable（明显） abdominal mass. The laboratory, in most cases, revealed anemia, leukocytosis（白细胞增多） very increased ESR, pyuria（脓尿）, hematuria （血尿）and bacteriuria（细菌尿）. pathology The pathology on macroscopic examination shows usually a kidney yellow, enlarged in size, and with stones inside. Macroscopic view of the inside of a surgical specimen of a kidney with XP. Presence of multiple cystic cavities. 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 histiocytes sparkling grouped and contained lipids, which are called xanthoma（黄色瘤） cells that are associated with a diffuse inflamma- tory infiltrates, where cells are round, the plasmocytes（浆细胞）. foam（泡沫细胞） cells (arrow up), multinucleated(多核） giant (downward arrow) and mononuclear inflammatory infiltrate. Comprehensive imaging manifestation of XGP 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 volum