PMC3336244_01
PMC3336244_02
(a) Unenhanced CT of the abdomen displays a large, contour deforming mass arising in the lower pole of the right kidney. The mass contained no visible calcifications, involved the renal capsule, and infiltrated the perinephric fat. (b) More inferiorly, the mass clearly involved the ipsilateral psoas muscle and, after going through the perinephric space and fascia, it extended into the posterior paranephric space. There is no retroperitoneal lymphadenopathy. The right renal vein was of normal caliber on higher slices through the renal hilum. (c) Gross examination. The mass involved renal parenchyma with extrarenal extension. (d) Granulomatous inflammation with abscess involved renal parenchyma, H&E, x50. (e) Granuloma with adjacent abscess was seen in the renal parenchyma, H&E, x400. (f) Grocott stain was positive for pseudohyphae and yeast forms, x400.
CRIM.ID2012-953590.001.jpg
PMC3336244_02_CRIM.ID2012-953590.001.jpg
fig1
In its entirety, this mass measured 10.7 x 9.6 x 11.9 cm (Figures 1(a) and 1(b)). On cut surface, it showed a large, poorly circumscribed, heterogeneous, and necrotic mass in the lower pole of the kidney measuring 13.0 x 5.0 x 6.0 cm (Figure 1(c)) and extending to the perinephric fat. Histologically the mass was composed of acute and chronic inflammation with abscess formation, fibrosis, and granulomas (Figures 1(d) and 1(e)). Grocott stain for fungus was positive for pseudohyphae and yeast forms (Figure 1(f)) compatible with Candida spp. Gram and acid fast stains were negative.