Antopol-Goldman Lesion Research Articles

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

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.

Lésion d'Antopol-Goldman (Antopol-Goldman lesion)

Lésion d'Antopol-Goldman (Antopol-Goldman lesion) is a rare condition characterized by renal pelvic subepithelial hematoma simulating a neoplastic process. A 71-year-old lady presented with macroscopic hematuria and hypoenhancing mass lesion at the upper pole of left kidney. The patient underwent a radical nephrectomy for suspected renal cell carcinoma. Macroscopically a 3.5cm circumscribed hemorrhagic mass lesion was noted flush with the upper pole pelvicalyceal system. Microscopic examination revealed a pelvic subepithelial (suburothelial) organizing hematoma. Extensive sampling did not reveal any neoplastic etiology. The adjacent renal parenchyma and renal vessels were unremarkable. Antopol-Goldman lesion is a diagnostic quagmire, often culminating in unnecessary nephrectomy. This is a rare entity, and clinical awareness as a differential of renal filling defect can preclude a nephrectomy, we hereby discuss its clinico-pathological and treatment implications.

Computed tomography and magnetic resonance imaging of peripelvic and periureteric pathologies.

Peripelvic and periureteric areas are frequently overlooked in the imaging evaluations of the urinary system on computed tomography and magnetic resonance imaging. Several neoplastic and non-neoplastic disorders and diseases including lipomatosis, angiomyolipoma and angiolipomatous proliferation, vascular lesions, lymphangiomatosis, Rosai-Dorfman disease, Erdheim-Chester disease, extramedullary hematopoiesis, IgG4-related disease, lymphoma, mesenchymal tumors, trauma, and Antopol-Goldman lesion may involve these areas. Differentiation of these benign or malignant pathologies among themselves and from primary renal pathologies is of utmost importance to expedite the triage of patients for correct treatment approach. In this article, we aim to increase the awareness of the imaging specialists to the typical and atypical imaging features of the entities affecting these areas.

Imaging of adrenal and renal hemorrhage.

Hemorrhage of the kidneys and adrenal glands has many etiologies. In the adrenal glands, trauma, anticoagulation, stress, sepsis, surgery, and neoplasms are common causes of hemorrhage. In the kidneys, reasons for hemorrhage include trauma, bleeding diathesis, vascular diseases, infection, infarction, hemorrhagic cyst rupture, the Antopol-Goldman lesion, and neoplasms. Angiomyolipoma and renal cell carcinoma are the neoplasms most commonly associated with hemorrhage in the kidneys and adrenal cortical carcinoma, metastases, and pheochromocytoma are associated with hemorrhage in the adrenal glands. Understanding the computed tomography and magnetic resonance imaging features, and causes of hemorrhage in the kidneys and adrenal glands is critical. It is also important to keep in mind that mimickers of hemorrhage exist, including lymphoma in both the kidneys and adrenal glands, and melanoma metastases in the adrenal glands. Appropriate imaging follow-up of renal and adrenal hemorrhage should occur to exclude an underlying malignancy as the cause. If there is suspicion for malignancy that cannot be definitively diagnosed on imaging, surgery or biopsy may be warranted. Angiography may be indicated when there is a suspected underlying vascular disease. Unnecessary intervention, such as nephrectomy, may be avoided in patients with benign causes or no underlying disease. Appropriate management is dependent on accurate diagnosis of the cause of renal or adrenal hemorrhage and it is incumbent upon the radiologist to determine the etiology.

Subepithelial pelvic hematoma of the kidney (Antopol-Goldman Lesion).

Renal pelvic hematoma (Antopol Goldman lesion) is a rare but significant condition that may clinically mimick a renal or a pelvic neoplasm. Differential diagnosis and optimal treatment are still not known certainly. A 80-year-old male patient admitted to the emergency department with gross hematuria/clot retention and right flank pain. Magnetic resonance imaging (MRI) imaging revealed a filling defect in the right renal pelvis. Diagnostic flexible uretrorenoscopy was performed and a renal pelvic tumor was excluded. A 6 Fr double J (DJ) ureteral catheter was placed for 4 weeks while the patient was under an antifibrinolytic therapy. Filling defect was not detected at 3(rd) month control MRI. During 6 months of the follow-up period, gross hematuria or any abnormal radiological finding was not encountered.

Subepithelial pelvic hematoma

IntroductionSubepithelial pelvic hematoma (Antopol–Goldman lesion) is a rare condition that clinically simulates a renal or pelvic neoplasm, whose final diagnosis is established in most of the cases by the pathologist after the nephrectomy. To avoid this, imaging tests and high diagnostic suspicion are essential. Material and methodsThe case of a 43-year-old female patient is presented. She had no background of interest and she came due to experiencing an acute pain in the left renal fossa after a physical effort. This patient was studied by Ultrasonography, Computed Tomography (CT), and evolutively with magnetic resonance (MR). ResultsThe X-ray studies showed a lesion in the left renal sinus with characteristics suggestive of subepithelial renal pelvis hematoma, without data suggesting underlying lesion. The treatment of the patient was conservative, confirming the disappearance of the lesion in the follow-up studies. ConclusionKnowledge of the X-ray findings of the Antopol–Goldman lesion in different imaging tests and an elevated index of suspicion are crucial in the management of patients affected by this uncommon condition. These make it possible to avoid an unnecessary nephrectomy.

Hematoma pélvico subepitelial

IntroductionSubepithelial pelvic hematoma (Antopol Goldman lesion) is a rare condition that may clinical and radiologically simulate a renal or pelvic neoplasm and whose final diagnosis has been established after nephrectomy in most published cases. To avoid misdiagnosis, imaging tests and high diagnostic suspicion are essential. Material and methodsWe present the case of a 43-year-old woman with no background of interest who was admitted to our Hospital complaining of acute left flank pain after a physical effort. The patient was studied by Ultrasonography, Computed Tomography and evolutively by Magnetic Resonance Imaging. ResultsThe radiologic exams showed a lesion in the left renal sinus with characteristics suggestive of subepithelial pelvic hematoma and without data revealing any underlying lesion. The patient was treated conservatively and follow-up examinations confirmed the disappearance of the lesion. ConclusionKnowledge of the radiologic features of Antopol Goldman lesion as well as a high degree of clinical suspicion are crucial in the management of patients affected by this uncommon condition and may avoid an unnecessary nephrectomy.

Subepithelial Pelvic Hematoma (Antopol—Goldman Lesion) Simulating Renal Neoplasm: Report of a Case and Review of the Literature

The Antopol-Goldman lesion is a subepithelial pelvic hematoma simulating a renal neoplasm. We report the clinico-pathological features of a single case and a review of the literature. A 76-year-old man presented with flank pain and hematuria. Computed tomography showed a hypodense lesion of 6 cm at the left kidney with filling defect at pyelogram. The patient underwent nephroureterectomy for suspected neoplasm. Macroscopically, a mass of 6 cm was present impinging on the pelvi-caliceal system. Microscopically, the lesion was composed by hemorragic material with feature of an hematoma. A diffuse eosinophilic amorphous material suspicious for amyloid was observed among intra- and extraparenchymal vessels. The Congo-Red staining verified the presence of amyloid. The diagnosis was subepithelial pelvic hematoma with severe amyloidosis. Antopol-Goldman lesion should be kept in mind as a possible differential diagnosis of upper urinary tract lesion to avoid unnecessary nephrectomies. The anamnestic knowledge of amiloydosis may increase this diagnostic hypothesis.

Antopol-goldman lesion of the kidney diagnosed by radiology: a case report of observation

Antopol-Goldman lesions are extremely rare and are characterized by subepithelial hematoma in the renal pelvis. There have been at least 28 case reports in the literature, with all being diagnosed histologically after partial or total nephrectomy for a presumed malignancy. We report the first case in the literature to be diagnosed by radiological imaging and followed on an observatory basis.

Hematoma subepitelial de la pelvis renal como causa de defecto de repleción en el estudio radiológico del tracto urinario superior

After taking care of a patient with suspicion of upper urinary tract neoplasia which was finally diagnosed of renal pelvis subepithelial hematoma (Antopol-Goldman lesion), we decided to review such unfrequent pathology with the aim to summarize its main characteristics. The patient presented clinically and radiologically as an upper urinary tract tumor and underwent nephroureterectomy. Past history was significant for oral anticoagulative treatment after deep vein thrombosis. Pathologic study of the nephrectomy specimen reported absence of urothelial tumor and presence of a subepithelial hematoma of the renal pelvis, which explained both clinical manifestations and radiological findings. Our case is very similar to the other 27 published in the bibliography. Subepithelial hematoma of the renal pelvis is a benign lesion, more frequent in females, which appears between the fourth and sixth decades of life. Not much is known about its etiopathogenesis, it probably is a multifactorial process. It simulates an upper urinary tract urothelial tumor, both clinically and radiologically, and so is treated in most published cases. It is necessary to know this entity as possible differential diagnosis of upper urinary tract radiological study filling defects to avoid non necessary nephrectomies.

Lésion d'Antopol-Goldman : une cause rare d'hématurie

An Antopol-Goldman lesion or subepithelial pelvic hematoma of the kidney is a rare cause of hematuria. We described a 26 year-old man hospitalized for macroscopic hematuria associated with a subepithelial hematoma whose development might have been favored by arterial hypertension secondary to a renal artery stenosis.

Hematoma subepitelial de pelvis renal y uréter: lesión de antopol-goldman

The subepithelial hematoma of the renal pelvis and ureter was described by Antopol and Goldman in 1948. Hematuria and filling defect in the renal pelvis are the most consistently recurring clinical and radiological findings. Only 21 cases were found in the literature on the subject and all of them were treated surgically, usually with partial or total nephrectomy. Here we present a case of Antopol-Goldman lesion which was treated conservatively

Subepithelial hemorrhage of renal pelvis simulating neoplasm (Antopol-Goldman lesion)

Two cases of peripelvic hemorrhage simulating tumors (Antopol-Goldman lesion) are reported. In the 2 cases, nephrectomies were performed. With more knowledge of this lesion, and of its rapid disappearance, a waiting period and repeated intravenous pyelogram might prevent some unnecessary surgery.