脂肪性腎病變: 病例和文獻回顧
詹凱勝、方嘉郎、溫玉清*
臺北醫學大學市立萬芳醫院 泌尿科
臺北醫學大學市立萬芳醫院 病理科
Renal Replacement Lipomatosis: A rare case and literature review
Kai-Sheng Chan, Chia Lang Fang, Yu-Ching Wen*
Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
We present a case of a 41 year old female with past history of hepatitis B virus infection. She suffered from persisted back soreness for many years without low urinary tract symptoms or gross hematuria. Abdominal CT found a fat density lesion with mass effect at left retroperitoneum extending from renal sinus and hilum extending perirenally with mostly towards left upper pole of left kidney. CT-guided biopsy disclosed pathology report of lipomatous tumor with finding of mature fibroadipose tissue, few small to medium-sized blood vessels but no muscular tissue. The favoring diagnosis was left renal replacement lipomatosis. Transarterial embolization of small feeding vessels to left renal mass was done. Follow-up abdominal CT in three months showed decreased left lipomatous tumor indicating it as an effective treatment.
Renal replacement lipomatosis or also termed fibrolipomatosis is a relatively rare condition in which proliferation of perirenal fat tissue progressively replaces renal parenchyma resulting in renal atrophy and destruction of kidney function. It usually occurs unilaterally and is commonly associated with renal calculi and chronic renal infection. Clinical symptoms are non-specific with recurrent urinary tract infection and flank pain being the most common. Diagnostic tools include abdominal ultrasound, intravenous urography and contrast enhanced computed tomography. Progressive replacement of renal parenchyma often leads to renal atrophy and destruction of renal function. Due to its rare entity, it should always be kept in mind by specialist during differential diagnosis of renal tumor and be able to adequately inform patient of its poor prognosis. As no standard treatment of controlling renal replacement lipomatosis is available at this time, embolization showed to be an effective treatment option.