资源描述:
《黄色肉芽肿性肾盂肾炎.ppt》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、Xanthogranulomatouspyelonephritis黄色肉芽肿性肾盂肾炎IntroductionXanthogranulomatouspyelonephritis(XGP)isanunusualformofchronicpyelonephritisinwhichtherenalparenchyma(肾实质)isdestroyedandreplacedbylipid-ladenfoamymacrophages(充满脂质的巨噬细胞).Itisalmostalwaysunilateral(单侧).Itoccursin1%ofallrenalinfection
2、s.XGPis4timesmorecommoninfemalesthaninmenandisusuallynotedinthefifthandsixthdecadesoflife.TheexactetiologyofXGPisunknown,butitisgenerallyacceptedthatthediseaseprocessrequireslong-termrenalobstruction(障碍)andinfection.Stonesmayoccurin75%ofpatientswithXGPbutarenotrequiredtomakethediagnosi
3、s.Theclinicalpresentationofpatients:lumbar(腰痛)andabdominalpain,weightloss, urinary(泌尿系)symptoms,paleconjunctiva(结膜),kidneystonesandchronicevolutionofthedisease.Highfeverandpalpable(明显)abdominalmass.Thelaboratory,inmostcases,revealedanemia,leukocytosis(白细胞增多)veryincreasedESR,pyuria(脓尿),
4、hematuria(血尿)andbacteriuria(细菌尿).pathologyThepathologyonmacroscopicexaminationshowsusuallyakidneyyellow,enlargedinsize,andwithstonesinside.MacroscopicviewoftheinsideofasurgicalspecimenofakidneywithXP.Presenceofmultiplecysticcavities.Microscopicexaminationmacrophagesareloadedwithfat(his
5、tiocytessparkling(闪闪发光的)),explaininghiscolor,inadditiontonecrosisandinfiltration(渗出物)withleukocytesandplasmaticcellshistiocytessparklinggroupedandcontainedlipids,whicharecalledxanthoma(黄色瘤)cellsthatareassociatedwithadiffuseinflamma-toryinfiltrates,wherecellsareround,theplasmocytes(浆细胞)
6、.foam(泡沫细胞)cells(arrowup),multinucleated(多核)giant(downwardarrow)andmononuclearinflammatoryinfiltrate.ComprehensiveimagingmanifestationofXGPA44-year-oldwomanwhoreportedurinarysymptomsforthepast6months.ComputedtomographywastypicalfordiffuseXGP:enlargedleftkidneywithavoluminous(大量)central
7、staghorncalculusandhydronephrosis.Therenalparenchymaisreplacedbymultipleconfluentfluid-filledmasses).imagingmanifestationofXGPDiffuseXGPinan87-year-oldman.Apost-contrastenhancedCTimagedemonstratesdiffuseenlargementoftheleftkidneywithmassivepelvicdilatationandmajorcaliectasis.imagingm