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Wegener's Granulomatosis Presenting As a Renal Mass

Kyrsten D. Fairbanks1, David B. Hellmann2, Elliot K. Fishman3, Syed Z. Ali4 and John H. Stone5

1 Department of Medicine, 600 N. Wolfe St., Nelson Tower 110, Baltimore, MD 21287.
2 Department of Medicine, Division of Rheumatology, Johns Hopkins University, 1830 E. Monument St., Ste. 9030, Baltimore, MD 21205.
3 Department of Radiology, Johns Hopkins University, Johns Hopkins Outpatient Center, Caroline St., Rm. 3254, Baltimore, MD 21205.
4 Department of Pathology, Division of Cytopathology, Johns Hopkins University, 600 N. Wolfe St., Meyer 434, Baltimore, MD 21287.
5 Department of Medicine, Division of Rheumatology, Johns Hopkins University, Johns Hopkins Vasculitis Center, 1830 E. Monument St., Ste. 7500, Baltimore, MD 21205.



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  		Fig. 1A. —68-year-old man who presented with mastoiditis, pulmonary infiltrates, fever, and weight loss. Axial contrast-enhanced CT scan reveals left renal mass. Note 4 x 3 cm mass (straight arrow) in posterior aspect of left kidney's mid pole, and 1.5 x 2 cm mass (curved arrow) laterally. Also note lymphadenopathy in paraaortic and aortocaval regions at level of renal hila, with nodes measuring as large as 1 cm in diameter.

 


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  		Fig. 1B. —68-year-old man who presented with mastoiditis, pulmonary infiltrates, fever, and weight loss. Photomicrograph obtained at fine-needle aspiration shows multinucleated giant cells and collection of histiocytes. (Diff Quik [Dade Behring, Newark, DE], x200)

 


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  		Fig. 1C. —68-year-old man who presented with mastoiditis, pulmonary infiltrates, fever, and weight loss. Photomicrograph from core biopsy shows extensive necrotizing inflammation, glomerular involvement with focal sclerosis, and fibrinoid necrosis of small blood vessel. (H and E, x100)

 

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