Pseudotumor presentation of renal tuberculosis mimicking renal cell carcinoma: A rare entity

Renal tuberculosis mimicking cystic renal cell carcinoma: A case report

Renal tuberculosis is a rare and often under-recognized condition, frequently leading to delayed diagnosis due to its nonspecific symptoms and atypical clinical presentation. We report a case of renal tuberculosis initially masquerading as a renal cystic tumor in a 56-year-old woman. This case highlights the crucial importance of a thorough clinical and diagnostic approach to differentiate renal tuberculosis lesions from renal cystic tumors. Early and appropriate management of this condition can help avoid complications and improve patient prognosis.

The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis

Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.

Imaging of Renal Infections and Inflammatory Disease

Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Diagnosis is based on clinical findings of fever, flank pain, and urinary tract infection. Computed tomography findings include renal enlargement with wedge-shaped heterogeneous areas of decreased enhancement, known as a "striated nephrogram." Imaging is primarily used to diagnose complications such as emphysematous pyelonephritis, renal abscess, and pyonephrosis. Chronic pyelonephritis can have varying appearances on imaging ranging from xanthogranulomatous pyelonephritis or, in extreme cases, renal replacement lipomatosis.

Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging

PURPOSE

To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis.

CONCLUSION

Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.

Renal tuberculosis mimicking renal cell carcinoma: a case report

Background

Urogenital tuberculosis is still a frequent presentation, and it constitutes a current public health problem in endemic areas. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon.

Case presentation

We present a case of a 52-year-old African woman who presented with urogenital tuberculosis in its pseudotumoral form. This case was initially diagnosed and managed as renal cancer. Histopathology confirmed the diagnosis of pseudotumoral renal tuberculosis.

Conclusions

The pseudotumoral form of urinary tuberculosis can be difficult to diagnose. Only bacteriological or histological confirmation allows diagnosis for adequate treatment.

Clinicopathological analysis of renal inflammatory pseudotumors presenting as the unilateral solitary masses

Renal inflammatory lesions rarely present as unilateral solitary mass. These types of lesions are often misdiagnosed as renal tumors that lead to unnecessary nephrectomy. So far there are very few comprehensive studies about both their clinical features and pathologic characteristics of these inflammatory pseudotumors. Six renal inflammatory pseudotumors were identified in atotal of 1195 radical or partial nephrectomy cases retrospectively reviewed in our institution. The inflammatory lesions included xanthogranulomatous pyelonephritis (2 cases), renal tuberculosis (1 case), renal malakoplakia (1 case), IgG4-related tubulointerstitial nephritis (1 case), and renal Wegener's granulomatosis (1 case). All patients underwent radical nephrectomy because they had the unilateral renal solitary mass by the imaging examination. Following the postoperative pathological diagnosis, these patients received anti-inflammatory therapy according to their specific etiology. In conclusion, the attention must be paid for rare renal inflammatory pseudotumors that may mimic tumors since these diseases require a total different treatment strategy from neoplastic diseases.