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We describe a case of renal cell carcinoma which causes difficulties to set diagnosis with imaging methods. The histological examination revealed renal cell carcinoma associated with epithelioid cell granuloma with caseous necrosis. Granulomatous inflammation is characterized by the accumulation of epithelioid histiocytes and multinucleated giant cells. The cause of granuloma formation can be infectious or non-infectious. Granulomatous response in renal cell carcinoma is rare. This case shows that for accurate diagnosis for suspected tumor is necessary to be used combination of complex imaging-triplex ultrasound, CEUS, CT and histological examination.

AbstractRetroperitoneal fibrosis (RPF) is a rare disease associated with the development of chronic inflammation and fibrogenesis in the retroperitoneal space. The disease usually manifests with acute or acute over chronic renal failure and/or urosepsis. Pancreatic involvement in RPF is rare but has been described in the literature. The diagnosis of RPF is made mainly by imaging methods. Abdominal echography scan reveals the presence of an obstruction with or without inflammation; computed tomography and magnetic resonance imaging show the type and the spreading of fibrosis. Here, we report a 50-year-old female patient diagnosed with RPF during operative intervention in 2003. Initial treatment with corticosteroids and tamoxifen lead to remission. In 2007, late recurrence was observed, with tumor-like lesions over the upper, posterior, and anterior surfaces of the pancreas, spreading to intraperitoneal structures and more pronounced on the left side. Abdominal echography on day 30 showed that corticosteroid treatment lead to a decrease in the tumor-like lesions.