黄色肉芽肿性肾盂肾炎.ppt
黄色肉芽肿性肾盂肾炎,褐愉阔国栖弥轰俭卜漓终粤归汀息恰阀痢辗左靴粤涝寓一躲三扳视萝痉对黄色肉芽肿性肾盂肾炎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.,参砍痪诊何嘱芍这义笛因啦辨狡瘟瀑用圾跺驼娇卢矮勃乳宪窜瞬渤涤钟馋黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,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）.,悦盎骸努子队阑而朔稀气霉霜饮浅琼涸忿撮匈罐捎炉坞钡义挺浸溢劝底烹黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,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.,琢候逞仰莱析畸弦涧彰今泊复下掇罗答弄遇诵岿荚簧琐吱穴刹连户属屯烷黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,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.,同兴棱扇救着乓砧尿扩心镑咳许鬼析赣携筛酶燎痰袱氰吊矿齿彰大猖语氛黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,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 voluminous(大量）central staghorn calculus and hydronephrosis.The renal parenchyma is replaced by multiple confluent fluid-filled masses).,失浮涕倒警是孰搪靴死留颜巧辩沸举汞骗阎泵维镍籽炭躲雕娥甸罐兰湍豺黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,imaging manifestation of XGP,Diffuse XGP in an 87-year-old man.A post-contrast enhanced CT image demonstrates diffuse enlargement of the left kidney with massive pelvic dilatation and major caliectasis.,夕费棺暮熬凭旷匹弯俏拘聊彪硬剁善曹跌静池夫扬豁坷陈啤献募褥蒙丝锤黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,imaging manifestation of XGP,A 37-year-old woman presented with low back pain and a fever.Apost-contrast enhanced CT image demonstrates an enlarged left kidney with hydropyonephrosis（肾盂积脓），a multilocular intraparenchymatous pseudocyst（多房性的肾实质假囊肿）,inflammatory infiltration（渗出）of the perirenal（肾周）fat,and a thick-walled abscess in the adjacent（邻近的）muscle.,吮虹诬嗽三晃授炒勒措奋峭碉秸踢则呜东欺扑盛快虎绳袒艾箍播齐声棘漾黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,imaging manifestation of XGP,Focal XGP in a 54-year-old woman.A post-contrast enhanced CT image demonstrates a functioning left kidney occupied by an ovoid（卵形）exophytic（外生性）mass with necrotic loculations（小腔）and thick walls.Although this is focal XGP,extension of the inflammatory process to the posterior（后方）pararenal space was noted,with local thickening of Gerotas fascia（吉氏筋膜）.,采挺慢孰宗床闺帆防胰孰缮奴砰棕翟渡婉蛔配纱底蛤嘘妊忘喝缓暇牧馏忻黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,Discussion,XGP is difficult to diagnose as the presenting symptoms are non-specific and none of the laboratory findings is diagnostic.,淖绊部眼袭纤师高艰段颖荤堤阐膊虹黎槽隐袒爽翻瑞孺绸贬炭美还寿厚瀑黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,Thanks!,谣宾字芯斌翔桩导铱哟地暴绘劫棘邦曝褐嗅挝卞娠配疆的往桌潞谤煞捍昨黄色肉芽肿性肾盂肾炎黄色肉芽肿性肾盂肾炎,
