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Johns Hopkins Hospital Baltimore, MD 21287-0801
We greatly appreciate the interest in our article [1] and the comments about the images shown. The patient shown in Figure 3 of our article had multiple ill-defined peripheral hypodense lesions in the bilateral kidneys in addition to multiple cysts. The ill-defined peripheral hypodense lesions are similar to the cases described in the letter by Dr. Brennan and Dr. Pedrosa. For our patient shown in Figure 3, the renal lesions were interpreted as suspicious for infiltrative process, but biopsy was not performed, and unfortunately the pathologic diagnosis of the renal lesions was not made.
The patient in Figure 3 of our article had follow-up abdominal CT 3 months later, and the peripheral hypodense renal lesions appeared less obvious than on the initial CT. In this patient, there was also a left hilar mass extending into the aortopulmonary window with bulky adenopathy in the mediastinum and right hilum. Biopsy of the left hilar mass and mediastinal adenopathy under mediastinoscopy and limited anterior thoracotomy revealed an anthracotic lymph node with fibrosis and chronic inflammation, which was nonspecific and did not indicate a specific cause for fibrosis. The histologic findings were not diagnostic of sclerosing mediastinitis, but that entity could not be excluded.
In a recent review of autoimmune pancreatitis, Sahani et al. [2] describe a patient with autoimmune pancreatitis who had renal "pseudotumor." In that particular patient, there was also associated retroperitoneal fibrosis with mediastinal and hilar adenopathy.
Although there was no pathologic diagnosis in our case shown in Figure 3, the renal lesions may represent a systemic disease process of autoimmune phenomena as Dr. Brennan and Dr. Pedrosa suggested.
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