Fukui Hikari, Fujimori Masashi, Yamanaka Takashi, Matsushita Naritaka, Kishi Seiya, Nagata Chisami, Omori Yuki, Nishikawa Kouhei, Yuasa Hiroto, Sakuma Hajime
Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Department of Nephro-Urologic Surgery and Andrology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Radiol Case Rep. 2022 Jul 22;17(9):3419-3424. doi: 10.1016/j.radcr.2022.06.084. eCollection 2022 Sep.
Infectious granulomas arising in the kidney are rare. However, there are few reports regarding renal granulomas, such as xanthogranulomatous pyelonephritis, sarcoidosis, malakoplakia, and tuberculosis. Here, we report a case of cryptococcal granuloma resembling a locally progressed tumor after percutaneous cryotherapy for renal cell carcinoma. A male patient in his 80s with rheumatoid arthritis underwent computed tomography (CT)-guided cryoablation for biopsy-proven papillary renal cell carcinoma. Follow-up contrast-enhanced CT imaging obtained 4 months after ablation confirmed an enhanced mass on the edge of the ablation zone. There were no symptoms related to the mass. This mass was radiologically diagnosed as local tumor progression and treated with repeated cryoablation. Percutaneous biopsy of the mass was performed immediately after the second cryoablation, and the mass was pathologically diagnosed as granuloma related to infection. The patient was administered antifungal fluconazole for 1 year with a good outcome.
肾脏中出现的感染性肉芽肿很罕见。然而，关于肾肉芽肿的报道较少，如黄色肉芽肿性肾盂肾炎、结节病、软斑病和结核病。在此，我们报告一例肾细胞癌经皮冷冻治疗后出现类似局部进展性肿瘤的隐球菌肉芽肿病例。一名80多岁患类风湿性关节炎的男性患者，因经活检证实的乳头状肾细胞癌接受了计算机断层扫描（CT）引导下的冷冻消融术。消融术后4个月进行的随访增强CT成像证实消融区边缘有一个强化肿块。与该肿块相关的无症状。该肿块经放射学诊断为局部肿瘤进展，并接受了重复冷冻消融治疗。第二次冷冻消融后立即对该肿块进行了经皮活检，病理诊断为与感染相关的肉芽肿。患者接受了1年的抗真菌氟康唑治疗，效果良好。
