Talal Al-Qaoud1, Fadi Brimo2, Armen G Aprikian1, Sero Andonian1. 1. Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC; 2. Department of Pathology, McGill University, McGill University Health Centre, Montreal, QC.
Abstract
INTRODUCTION: The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively. CASE REPORTS: The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without anti-tuberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications. CONCLUSIONS: While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without anti-tuberculous medications.
INTRODUCTION: The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively. CASE REPORTS: The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without anti-tuberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications. CONCLUSIONS: While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without anti-tuberculous medications.
Authors: Cyrill A Rentsch; Frédéric D Birkhäuser; Claire Biot; Joël R Gsponer; Aurélie Bisiaux; Christian Wetterauer; Micheline Lagranderie; Gilles Marchal; Mickael Orgeur; Christiane Bouchier; Alexander Bachmann; Molly A Ingersoll; Roland Brosch; Matthew L Albert; George N Thalmann Journal: Eur Urol Date: 2014-03-12 Impact factor: 20.096
Authors: D L Lamm; P M van der Meijden; A Morales; S A Brosman; W J Catalona; H W Herr; M S Soloway; A Steg; F M Debruyne Journal: J Urol Date: 1992-03 Impact factor: 7.450
Authors: Maciej Borówka; Stanisław Łącki-Zynzeling; Michał Nicze; Sylwia Kozak; Jerzy Chudek Journal: Cancers (Basel) Date: 2022-08-23 Impact factor: 6.575