Granulomatous renal masses following intravesical bacillus Calmette Guérin therapy: the central unaffected calyx sign.
A 67-year-old man with a history of melanoma, treated surgically 7 years before, was referred for vomiting and right flank pain after three intravesical instillations of bacillus Calmette-Guérin (BCG) for superficial bladder cancer. A CT scan showed a mass on the right kidney, with a normal calyx in its centre. Percutaneous biopsy, obtained because of melanoma history, showed granulomatous reaction caused by BCG infection. The renal mass disappeared after 9 months of anti-tuberculous treatment. The presence of an unaffected calyx in the centre of the renal mass is an interesting finding for both teaching purposes--it clearly illustrates the pathogeny of the disease, with the bacillus invading the renal parenchyma through the papilla--and diagnostic purposes--a malignant tumour is likely to displace or destroy neighbouring calyces rather than leaving them unaffected. However, the diagnostic value of this sign remains to be determined by further research.
Senés
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AT
Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, F-69437, France.
Badet
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L
Lyonnet
D
D
Rouvière
O
O
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000009:adverse effects*; D002278:Carcinoma in Situ / Q000188:drug therapy; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy; D006099:Granuloma / Q000000981:diagnostic imaging / Q000382:microbiology*; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000382:microbiology*; D008297:Male; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine