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The underlying pathogenetic mechanism in XGP is renal outflow obstruction (often caused by Staghorn calculi) in the setting of suppurative inflammation. Clinical presentation, radiographic features, and gross appearance of XGP may closely mimic a renal neoplasm making a correct pre-operative diagnosis difficult. Case contributed by: Liang Cheng, MD, Dept. of Pathology, Indiana University School of Medicine, Indianapolis.