Abstract

Introduction & Objective

Inflammatory Myofibroblastic tumour (IFMT) or ‘pseudotumour’ of the kidney is a rare benign tumour . It affects mostly young adults. Clinical examination and radiological investigations are either inconclusive or suggest malignant lesion. Renal mass biopsy is often inconclusive which necessitates a management in the line of Renal Cell Cancer (RCC) or Transitional Cell Carcinoma (TCC) as per presentation. Definitve diagnosis is based on histopathological analysis of the specimen by using immunohistochemistry^[1]. We are reporting a case of 16 yr old female who presented with hematuria & flank pain. Pre-op frozen section biopsy was done which was suggestive of transitional cell carcinoma. Radical nephroureterectomy was done & the final diagnosis based on histopathology & immunohistochemistry was turned out to be inflammatory myofibroblastic tumor of kidney.

Methods

A 16 year old female presented with complaint of mild dull aching pain in left flank area for 1 year. She had an episode of gross painless hematuria without any clots 1 year back.

Her clinical examination was normal. Ultrasound of kidney & urinary tract was done which was suggestive of left hydronephrosis and dilated upper ureter with no evidence of any stone. In view of the history of gross painless hematuria, a contrast enhanced CT scan was done. This was suggestive of a 2cm sized well defined, heterogeneous, mildly enhancing mass lesion in left renal pelvis. Decision was made to have a pre-operative diagnosis of the lesion as malignant tumor at such a young age was suspicious & a radical surgery would have profound impact on her quality of life. Hence she was posted for the diagnostic biopsy. Initially flexible ureteroscopy was attempted. However, the ureter was narrow & full of clots, so it couldn’t be done. Then decision was made for percutaneous biopsy of the mass through a nephroscope. Tissue was sent for frozen section analysis.