Abstract：
A 74-year-old woman presented to our hospital with the main complaint of anorexia and weight loss for several months. Computed tomography (CT) revealed right urinary stone, hydronephrosis, multiple lymphadenopathy, and a mass in the right kidney. Considering these findings, she was suspected to have renal malignancy (kidney or renal pelvis cancer) with multiple lymph node metastases; therefore, nephrectomy was performed. Her pathological diagnosis was xanthogranulomatous pyelonephritis (XGPN). There was no postoperative renal function decline, and multiple lymphadenopathy also disappeared on CT 3 months after surgery. It was judged to be reactive swelling due to inflammation. XGPN is a pathological condition characterized by accumulation of mast cells and activated macrophages in the renal tissue; and, the renal tissue recognizes yellowish granulation growth because of repeating pyelonephritis due to urinary tract passing impairment. In some cases, it is difficult to differentiate XGPN from renal malignancy. Moreover, lymphadenopathy may be lymph node metastasis but may also present reactive enlargement due to the effect of inflammation, making it even more difficult to differentiate when accompanied by lymphadenopathy. We report this case in which it was difficult to differentiate XGPN from renal malignancy considering the scarcity of reports of XGPN accompanied by multiple lymphadenopathy.
摘要：
一位74岁的妇女到我们医院就诊，主要主诉厌食症和体重减轻几个月。计算机断层扫描（CT）显示右侧尿路结石，肾积水,多发性淋巴结病,右肾有肿块.考虑到这些发现,她被怀疑患有肾脏恶性肿瘤（肾脏或肾盂癌），并有多个淋巴结转移；因此，进行肾切除术。病理诊断为黄色肉芽肿性肾盂肾炎（XGPN）。术后无肾功能下降,术后3个月CT上多发淋巴结肿大也消失。它被判断为由于炎症引起的反应性肿胀。XGPN是一种病理状况，其特征是肥大细胞和活化的巨噬细胞在肾组织中积累；并且，肾组织识别黄色肉芽生长，因为重复的肾盂肾炎，由于尿路通过障碍。在某些情况下,很难区分XGPN和肾脏恶性肿瘤。此外，淋巴结病可能是淋巴结转移，但也可能由于炎症的影响而出现反应性肿大，当伴有淋巴结病时，更难区分。我们报告了这种情况，考虑到XGPN伴有多发性淋巴结病的报道很少，因此很难将XGPN与肾脏恶性肿瘤区分开。
