CASE 35 (January 2009)

Clinical information

The patient is a 22-year-old woman; she was hospitalized for progressive right lumbar pain and tumefaction, fever and malaise of several months’ duration. She had a 12 year history of symptoms of intermittent tract urinary infections. An exhaustive study searching for a cause of the recurrent infections was not done.

On examination there were a fistulous tract in the right lumbar region. Laboratory investigations showed a normal renal function. Urinalysis revealed numerous leukocytes. An abdominal computed tomography scan revealed a right kidney displaced and compressed by a well-defined lesion with cystic aspect that is in contact with renal pelvis. Adjacent there is an ill-defined retroperitoneal mass which is in contact with the psoas and connecting to the fistulous tract (Figure 1). Left kidney appear normal.

Renal lesion is resected and a biopsy of the retroperitoneal mass is undertaken.

See the images.

Figure 1. CT showing the retroperitoneal mass (green arrows), the two green arrows signal the lumbar fistula. Blue arrows signal the renal cystic lesion. And red arrow signal the compressed right kidney.

Figure 2. Periphery of the cystic renal lesion. H&E, X100.

Figure 3. Periphery of the cystic renal lesion. H&E, X400.

Figure 4. Retroperitoneal mass. H&E, X400.

Figure 5. Retroperitoneal mass. H&E, X400.

Figure 6. Retroperitoneal mass. H&E, X400.

Figure 7. Retroperitoneal mass. H&E, X400.

Figure 8. Retroperitoneal mass. H&E, X1,000.

Figure 9. Retroperitoneal mass. PAS, X1,000.

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