A Rare Case of Unilateral Xanthogranulomatous Ureteritis Mimicking an Inferior Vena Cava Tumor

Abstract

Xanthogranulomatous pyelonephritis (XPG) is a known clinical entity; however, the further progression of this inflammatory pathology to adjacent organs, including the ureter, bladder and urethra, is extremely rare. Xanthogranulomatous inflammation of the ureter is a chronic inflammatory state where foamy macrophages are seen in the lamina propria along with multinucleated giant cells and lymphocytes forming a granulomatous inflammation, which is benign. Based on its appearance on computed tomography (CT) scan images, it can easily be misidentified as a malignant mass, and the patient can be subjected to surgery that can lead to complications. Here we present a case of an elderly male with a known case of chronic kidney disease with uncontrolled type 2 diabetes mellitus who presented with fever and dysuria. Upon further radiological investigations, the patient had underlying sepsis and was seen to have a mass involving the right ureter and inferior vena cava. Upon biopsy and histopathology, he was diagnosed with xanthogranulomatous ureteritis (XGU). The patient underwent further treatment and was followed up.

Keywords: ivc tumor; ureteritis; usg guided; xanthogranulomatous; xanthogranulomatous pyelonephritis.

Figure 1. Non-contrast computed tomography scan showing mass lesion along with right ureter and inferior vena cava

Figure 2. Doppler ultrasound of the patient

(A) Ultrasound of abdomen showing hydronephrosis. (B) Color Doppler image showing ureter along with mass lesion. (C) Color Doppler image showing the upper one-third of ureter and mass with inferior vena cava. (D) Color Doppler image showing the mass compressing and infiltrating the lumen of the inferior vena cava.

Figure 3. Ultrasonography-guided biopsy of mass lesion

Figure 4. Low- and high-power scanner images

(A) Low-power scanner image showing a core biopsy in which dense mononuclear inflammatory infiltrate can be appreciated (100x). (B) Higher magnification image showing a well-formed granuloma with numerous foamy histiocytes and macrophages representing a chronic inflammatory process (400x).

Figure 5. Higher magnification (400x) images showing scattered characteristic multinucleated Touton giant cells (A) and focal deposition of hemosiderin pigment (B).