Suburothelial hemorrhage masquerading as renal neoplasms: a case report of antopol Goldman lesion

Authors

  • Tanvi Vijay Department of Surgery, Lady Hardinge Medical College, New Delhi, India
  • Gyan Saurabh Department of Surgery, Lady Hardinge Medical College, New Delhi, India
  • Ranvir Singh Department of Surgery, Lady Hardinge Medical College, New Delhi, India
  • Smita Singh Department of Pathology, Lady Hardinge Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20231402

Keywords:

RCC, DVT, Suburothelial hematoma, Antopol Goldman lesion, TCC

Abstract

Renal cell carcinoma (RCC), which accounts for 2-3% of all adult malignancies, is one of the most lethal urologic cancers. They are sporadic in the majority of cases with 4-6% being familial. They are adenocarcinomas arising from renal tubular epithelial cells. They can present with symptoms of loin pain, palpable mass and haematuria. Another rare presentation is spontaneous perirenal haemorrhage which can be seen in up to 50% of these patients. These patients are also predisposed to increased risk of deep vein thrombosis (DVT) due to prevailing pro-thrombogenic state. Management requires radical nephrectomy for localised disease, targeted therapy and cytoreductive nephrectomy for metastatic RCC. Our patient is adult female who was referred to surgical OPD given her history of gross haematuria and right flank pain for 6 days. She is a known case of DVT on treatment with Warfarin for 4 years. A diagnosis of renal malignancy was made, contrast CT was suggestive of solid mass lesion of the upper pole of calyx likely transitional cell carcinoma (TCC)/papillary RCC. She underwent an urgent radical nephrectomy which showed a hard 5×5 cm lump in the upper pole of the kidney, revealing a clot on the cut section. Post-op HPE showed a large subcapsular hematoma in the upper pole with microscopy showing large areas of haemorrhage surrounded by chronic inflammatory infiltrate, likely Antopol Goldman lesion notorious for its similarity to renal malignancy.

References

Campbell SC, Lane BR, Pierorazio PM. Malignant Renal Tumors. In: Alan W. Partin, Roger R. Dmochowski, Louis R. Kavoussi, Craig A. Peters, eds. Campbell- Walsh-Wein Urology. 12th edition. Philadephia, PA: Elsevier. 2010.

Kekre N. The kidney and ureter. In: P. Ronan O’Connell, Andrew W. McCaskie, Robert D. Sayers, eds. Bailey and Love’s Short Practice of Surgery, 28th edition. Boca Raton: CRC Press, Taylor and Francis Group. 2023.

Antopol W, Goldman L. Subepithelial hemorrhage of renal pelvis simulating neoplasm. The Urologic and cutaneous review. 1948;52(4):189-95.

Morgan M, Bell D, Zhang E. Antopol-Goldman lesion. Reference article, Radiopaedia.org. Accessed on 19 Mar 2023.

Swati S, Arun C, Anupam C, Udupa CB, Kanthilata P, Vishwapriya MG. Lésion d'Antopol-Goldman (Antopol-Goldman lesion): Spontaneous renal pelvic subepithelial hematoma. Indian J Pathol Microbiol. 2022;65(1):173.

Sahin TK, Aladag E, Setterzade E, Guven GS, Haznedaroglu IC, Aksu S. Spontaneous subepithelial hemorrhage of renal pelvis and ureter (Antopol-Goldman lesion) in hemophilia A patient with inhibitor: Case report and review of the literature. Medicine. 2020;99(26).

Gayer G, Desser TS, Hertz M, Osadchy A, Daniel BL, Zissin R. Spontaneous suburothelial hemorrhage in coagulopathic patients: CT diagnosis. Am J Roentgenol. 2011;197(5):W887-90.

Pastor V, MJ RT. Subepithelial hemorrhage of renal pelvis (Antopol-Goldman lesion). Report of 4 cases and review of the literature. Actas Urologicas Espanolas. 2000;24(10):805-9.

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Published

2023-04-29

Issue

Section

Case Reports