ABSTRACT
Xanthogranulomatous pyelonephritis is associated with obstruction, stones and infection. CT is the mainstay of diagnosis, but appearances can mimic other conditions, including renal cell carcinoma. Nephrectomy is commonly recommended, but conservative treatment with antibiotics has been described after tissue diagnosis. We present a case of xanthogranulomatous pyelonephritis with concomitant renal cell carcinoma, which was an association that was suggested in 1988 and supported by subsequently reported cases. Conservative management of biopsy or cytology proven xanthogranulomatous pyelonephritis is unsafe, as an area of synchronous malignant tumour may be missed: we recommend it only in patients unfit for nephrectomy.
Subject(s)
Carcinoma, Renal Cell/diagnosis , Kidney Neoplasms/diagnosis , Pyelonephritis, Xanthogranulomatous/diagnosis , Aged , Carcinoma, Renal Cell/complications , Carcinoma, Renal Cell/diagnostic imaging , Diagnosis, Differential , Female , Fever/etiology , Humans , Kidney Neoplasms/complications , Kidney Neoplasms/diagnostic imaging , Nephrectomy , Pyelonephritis, Xanthogranulomatous/complications , Pyelonephritis, Xanthogranulomatous/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
An 80-year-old man with history of prostate cancer successfully treated with brachytherapy was initially thought to have Fournier's gangrene until imaging detected a rectoprostatic fistula. Although this is known to be a rare complication of prostate brachytherapy, in this case the aetiology was a new primary rectal adenocarcinoma. It was not possible to catheterise per urethra owing to the fistula, so he was fitted with suprapubic catheter, and underwent palliative loop colostomy. Brachytherapy carries a low risk of second primary cancers, although two previous cases reported such cancers as radiation induced. This is, to our knowledge, the first case of rectal adenocarcinoma following prostate brachytherapy in the literature.
