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Granulomatous renal masses following intravesical bacillus Calmette–Guérin therapy: the central unaffected calyx sign

¹ Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, F-69437, France, ² Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, F-69437, France, ³ Université de Lyon, Lyon, F-69003, France; Université de Lyon 1, Faculté de Médecine Lyon Nord, Lyon, F-69003, France, ⁴ Inserm, U556, Lyon, F-69424, France

Correspondence: Dr Olivier Rouvière, Department of Genitourinary and Vascular Radiology, Hôpital E. Herriot, 5 place d'Arsonval, 69437 Lyon Cedex 03, France. E-mail: Olivier.rouviere{at}netcourrier.com

A 67-year-old man with a history of melanoma, treated surgically 7 years before, was referred for vomiting and right flank pain after three intravesical instillations of bacillus Calmette–Guérin (BCG) for superficial bladder cancer. A CT scan showed a mass on the right kidney, with a normal calyx in its centre. Percutaneous biopsy, obtained because of melanoma history, showed granulomatous reaction caused by BCG infection. The renal mass disappeared after 9 months of anti-tuberculous treatment. The presence of an unaffected calyx in the centre of the renal mass is an interesting finding for both teaching purposes — it clearly illustrates the pathogeny of the disease, with the bacillus invading the renal parenchyma through the papilla — and diagnostic purposes — a malignant tumour is likely to displace or destroy neighbouring calyces rather than leaving them unaffected. However, the diagnostic value of this sign remains to be determined by further research.

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