A rare case of malakoplakia of the urinary bladder

Malakoplakia (from Greek Malako “soft” + Plako “plaque”) is a rare inflammatory condition that presents as a papule, plaque, or ulceration that usually affects the genitourinary tract. The most frequently affected organ is the urinary bladder. This condition has features of granulomatous inflammation. The pathogenesis of the disease is not completely understood. It is often misdiagnosed as malignancy. In this case report, we present a case of urinary bladder malakoplakia which presented with obstructive uropathy and acute kidney injury (AKI)

Malakoplakia of the prostate

Prostatic malakoplakia is a rare chronic inflammatory disease with only a few cases reported in the literature. It is believed to be caused by an impaired histiocytic response against bacteria. This is a case report of a 65-year- old man with a history of diabetes mellitus presenting with complaints of generalized weakness and fever of 4-day duration. Laboratory investigations showed pyuria, and urine culture showed Escherichia coli. An abdominal Computerised Tomography (CT) scan revealed left-sided pyelonephritis and a prostatic abscess. Double-J stenting with Trans-Rectal Ultrasound Scan (TRUS) biopsy was done. The biopsy showed features of malakoplakia of the prostate without any associated malignancy.

A case report of bladder malakoplakia in systemic sclerosis patient / 中华泌尿外科杂志

Systemic sclerosis is a rare and complex autoimmune disease, and malakoplakia is a rare chronic granulomatous inflammatory disease. Systemic sclerosis combined with malakoplakia is extremely rare. Diagnosis is difficult before surgery. It is easy to misdiagnose bladder malakoplakia as bladder tumor. This paper reports a middle-aged female patient with systemic sclerosis complicated with bladder malakoplakia. The main clinical manifestations were hematuria and bladder irritation, accompanied by severe diarrhea. Transurethral resection of bladder tumor was performed. Postoperative pathology proved that it was bladder malakoplakia. After the surgery, she continued to take low-dose prednisolone and methotrexate in the treatment of systemic sclerosis. The patient was followed up for 6 months.Transurethral cystoscopy was performed twice, and there was no recurrence.

Malakoplakia of Head and Neck Mimicking Malignant Lymphadenopathy: A Case Report / 대한이비인후과학회지

Malakoplakia is usually found in the genitourinary tract; however, it occurs uncommonly as a chronic inflammatory disease and rarely in the head and neck area, having been reported in the literature only few times. Here, we report, with a review of the related literature, a case of malakoplakia on the posterior neck. A 76-year-old male patient visited our institution presenting a rapidly growing neck mass that had invaded the overlying skin for several weeks. The results of imaging studies strongly indicated a malignant tumor, but an accurate diagnosis was not made until after a fine needle aspiration biopsy was undertaken twice. The lesion was completely excised with an extended radical neck dissection including the overlying skin and scalene muscle upon consent of the patient. The pathological diagnosis was made with various immunohistochemical staining methods including Von Kossa, Periodic acid-Schiff-diastase, CD-68 and CD163. During the 24 months follow-up after the surgery, there was no sign of recurrence.

Reporte de un caso de Malacoplaquia renal: una enfermedad inusual de difícil diagnóstico / Renal malokaplakia: An unusual disease of difficult diagnosis

RESUMEN La malacoplaquia es una enfermedad granulomatosa crónica inicialmente descrita en las vías urinarias, pero posteriormente encontrada en múltiples órganos. La presentación clínica depende del sitio comprometido; en el tracto urinario produce disuria, dolor pélvico o abdominal, fiebre, malestar general y, a veces, sensación de masa. Su etiopatogenia aún no ha sido completamente entendida, pero se cree que es debida a un trastorno en la función lisosomal de los macrófagos que afecta la destrucción de las bacterias. Histológicamente se caracteriza por presentar macrófagos llamados "células de von Hansemann" e inclusiones de Michaelis-Gutmann. Describimos el caso de una paciente con diabetes mellitus de larga evolución y malacoplaquia renal que le produjo síntomas debilitantes crónicos.

SUMMARY Malakoplakia is a chronic granulomatous disease, firstly described in the urinary tract but then it has been reported in many organs. The clinical presentation depends on the affected site, when it affects the urinary tract the symptoms are dysuria, abdominal or pelvic pain, fever, discomfort, and, something mass sensation. The etiopathogenesis is not yet clear, but is believed it is due to lysosomal dysfunction of the macrophages that affects the destruction of bacteria. Histologically it is characterized for the presence of von Hansemann cells and Michaelis-Gutmann bodies. We describe the case of a patient with long-term diabetes mellitus and renal malakoplakia that caused chronic debilitating symptoms.

Analysis of clinicopathologic characteristics, misdiagnosis and missed diagnosis of 4 malakoplakia cases / 中国肿瘤临床

Objective:To analyze the pathogenesis, clinicopathological characteristics, diagnosis, and treatment of the malakoplakia for the purpose of avoiding misdiagnosis and missed diagnosis. Methods:Clinicopathological features of four malakoplakia patients admit-ted to the Shanxi Cancer Hospital from March 2007 to March 2017 were studied by light microscopy, immunohistochemistry, and spe-cific stain technology, combining with a review of literature. Results:The onset age of the 4 patients (two males and two females) ranged 56-76 years (median:63 years). Two patients had malakoplakia in bladder;one patient had malakoplakia in bilateral ureters;and one case had malakoplakia in right pelvic. One patient has a history of systematic lupus erythematosis and diabetes. Malakoplakia is characterized by the accumulation of foam cells and concentrically-layered basophilic inclusions called Michaelis-Gutmann (M-G) bodies. The foam cells were positive for CD68 and PGM-1 by immunohistochemistry, indicating its derivation from the histocyte. M-G bodies were positive for periodic acid-Schiff reaction, iron, and calcium by specific staining technology. Conclusion:Malakoplakia is a rare inflammatory condition and a common urinary tract disease, but it may involve any organ with non-specific symptoms and can form tumor-like nodules that clinically simulate malignancy in various organs. Clinicopathological features can be used as diagnostic markers in malakoplakia diagnosis through specific stain technology.

Analysis of clinicopathologic characteristics, misdiagnosis and missed diagnosis of 4 malakoplakia cases / 中国肿瘤临床

Objective:To analyze the pathogenesis, clinicopathological characteristics, diagnosis, and treatment of the malakoplakia for the purpose of avoiding misdiagnosis and missed diagnosis. Methods:Clinicopathological features of four malakoplakia patients admit-ted to the Shanxi Cancer Hospital from March 2007 to March 2017 were studied by light microscopy, immunohistochemistry, and spe-cific stain technology, combining with a review of literature. Results:The onset age of the 4 patients (two males and two females) ranged 56-76 years (median:63 years). Two patients had malakoplakia in bladder;one patient had malakoplakia in bilateral ureters;and one case had malakoplakia in right pelvic. One patient has a history of systematic lupus erythematosis and diabetes. Malakoplakia is characterized by the accumulation of foam cells and concentrically-layered basophilic inclusions called Michaelis-Gutmann (M-G) bodies. The foam cells were positive for CD68 and PGM-1 by immunohistochemistry, indicating its derivation from the histocyte. M-G bodies were positive for periodic acid-Schiff reaction, iron, and calcium by specific staining technology. Conclusion:Malakoplakia is a rare inflammatory condition and a common urinary tract disease, but it may involve any organ with non-specific symptoms and can form tumor-like nodules that clinically simulate malignancy in various organs. Clinicopathological features can be used as diagnostic markers in malakoplakia diagnosis through specific stain technology.

Bladder Malakoplakia Mimicking Bladder Cancer / 대한내과학회지

Malakoplakia is an extremely rare granulomatous disease caused by infection and known to occur mostly in immune-compromised hosts. The most common site of involvement is the bladder. Patients with malakoplakia of the bladder present with multiple intravesical masses and are often misdiagnosed with bladder cancer. As a result, appropriate treatment is delayed. Here we report a case of a patient with malakoplakia of the bladder that was misdiagnosed as bladder cancer.

Colorectal malakoplakia in a child presenting as multiple polyposis coli.

Malakoplakia of the gastrointestinal tract is a rare chronic infl ammatory disorder, usually affecting the descending colon, sigmoid colon and rectum. It is commonly seen in adults. Only few cases have been reported in children. We report a case of malakoplakia of colon and rectum in a 7-year-old child who presented with multiple polyposis coli.

Malacoplaquia pulmonar associada à imunodeficiência por HTLV-1 e HIV / Pulmonary malakoplakia associated with immunodeficiency by HTLV-1 and HIV

Malakoplakia is a rare chronic inflammatory disease often confused with neoplasia. In this paper we report two cases of pulmonary Malakoplakia, both with typical clinical diagnosis of tuberculosis and lung cancer. A patient with human T-lymphotropic virus type I (HTLV-1) and diagnosis of adult T-cell leukemia/lymphoma, and another patient with human immunodeficiency virus (HIV), which was treated for tuberculosis, but, after pulmonary lobectomy, was evidenced Rodococosis equi, progressed to death...

Malacoplaquia é uma rara doença inflamatória crônica muitas vezes confundida com neoplasia. Neste artigo, relatam-se dois casos de malacoplaquia pulmonar, ambos com quadro clínico sugestivo de tuberculose e neoplasia pulmonar. Uma paciente com vírus T-linfotrópico humano tipo I (HTLV-1) e diagnóstico de leucemia/linfoma de células T do adulto, e um paciente com vírus da imunodeficiência humana (HIV), tratado para tuberculose, mas após lobectomia pulmonar foi evidenciado Rodococose equi, evoluindo para óbito...

Malakoplakia cervix misdiagnosed as Carcinoma cervix.

Malakoplakia cervix is still not reported in literature. Inflammatory lesions of cervix on visible appearance mimic as cervical malignancy. Histopathology confirms the diagnosis. Aim is to highlight the fact that errors occur in medical practice, if all differential diagnosis are not thought. A proper histopathological diagnosis is mandatory before final diagnosis.

Isolated malakoplakia of inguinal lymph node: A rare case report.

Malakoplakia is rare chronic infl ammatory disorder which commonly affects urinary tract. Though it has been reported in several sites outside the urinary tract, isolated lympnode involvement is extremely uncommon. Herein we present a case of 20 year old male with right inguinal lymphnodal mass. Histological fi ndings including special stains and immunohistochemistry fi ndings were characteristic of malakoplakia. This case is being presented to create awareness for inclusion of this entity in the differential diagnosis of lymphadenopathy.

Malakoplakia in a healthy young female patient

Malakoplakia is a rare granulomatous disease that occurs commonly in the urinary tract and secondarily in the gastrointestinal tract. Most reported cases of malakoplakia are associated with immunosuppressive diseases or chronic prolonged illness. Here, we report a rare case of malakoplakia in a young healthy adolescent without any underlying disease. A 19-year-old female was referred to our hospital following the discovery of multiple rectal polyps with sigmoidoscopy. She had no specific past medical history but complained of recurrent abdominal pain and diarrhea for 3 months. A colonoscopy revealed diverse mucosal lesions including plaques, polyps, nodules, and mass-like lesions. Histological examination revealed a sheet of histiocytes with pathognomonic Michaelis-Gutmann bodies. We treated the patient with ciprofloxacin, the cholinergic agonist bethanechol, and a multivitamin for 6 months. A follow-up colonoscopy revealed that her condition was resolved with this course of treatment.

Silent Colonic Malakoplakia in a Living-Donor Kidney Transplant Recipient Diagnosed during Annual Medical Examination

Malakoplakia is a characteristic inflammatory condition, which is usually seen in the urogenital tract, and less frequently in the gastrointestinal tract. We present a case of colonic malakoplakia in an immunocompromised patient. A 55-year-old female visited the outpatient clinic for routine cancer surveillance. Her past medical history was significant for kidney transplantation 11 years ago, and she had been taking immunosuppressants. A colonoscopy revealed several depressed flat lesions and elevated polyps, which were 0.3 to 0.4 cm in size and accompanied by whitish exudates. A biopsy revealed an infiltration of histiocytes with ample granular eosinophilic cytoplasm, with some lymphocytes and plasma cells. Many histiocytes had the characteristic morphology, described as Michaelis-Gutmann bodies: one or several round basophilic structures of approximately 1 to 10 microm in size with some being laminated, some appearing homogeneous, and others having a dense central core with a targetoid appearance. These Michaelis-Gutmann bodies were positively stained on von Kossa stain, and were diagnostic for malakoplakia.

Renal Parenchymal Malakoplakia Presenting with Abscesses and Hepatic Extension Misdiagnosed as a Malignant Tumor: A Case Report / 대한내과학회지

Malakoplakia is a chronic inflammatory disorder that usually affects the urinary tract in immunocompromised patients and rarely extends to adjacent organs. Due to its mass-like presentation, malakoplakia is often clinically misdiagnosed as a neoplastic lesion. We describe the case of a 51-year-old female with renal malakoplakia and hepatic extension and large intraperitoneal abscesses that had been misdiagnosed as malignancy. She was diagnosed with myasthenia gravis 12 years prior and had been treated with oral corticosteroids and immunosuppressants. Radical nephrectomy concomitant with abscess drainage was performed. The final pathology was compatible with malakoplakia, and the patient was successfully treated with antibiotics. Although renal malakoplakia is a rare disease, it should be included in the differential diagnosis of patients with a renal mass who have a history of recurrent urinary tract infections or evidence of immunosuppression.

Renal Parenchymal Malakoplakia Presenting with Abscesses and Hepatic Extension Misdiagnosed as a Malignant Tumor: A Case Report / 대한내과학회지

Malakoplakia is a chronic inflammatory disorder that usually affects the urinary tract in immunocompromised patients and rarely extends to adjacent organs. Due to its mass-like presentation, malakoplakia is often clinically misdiagnosed as a neoplastic lesion. We describe the case of a 51-year-old female with renal malakoplakia and hepatic extension and large intraperitoneal abscesses that had been misdiagnosed as malignancy. She was diagnosed with myasthenia gravis 12 years prior and had been treated with oral corticosteroids and immunosuppressants. Radical nephrectomy concomitant with abscess drainage was performed. The final pathology was compatible with malakoplakia, and the patient was successfully treated with antibiotics. Although renal malakoplakia is a rare disease, it should be included in the differential diagnosis of patients with a renal mass who have a history of recurrent urinary tract infections or evidence of immunosuppression.

Pulmonary malakoplakia: A report of two cases.

Malakoplakia of lung is an unusual condition that has been reported to occur in association with immunocompromised state, particularly in those with acquired immunodeficiency syndrome. We present two cases of pulmonary malakoplakia in immunocompetent individuals. The diagnosis was made on histopathological examination of surgically resected specimen.

Malakoplakia of the Kidney Extending to the Descending Colon in a Patient with Secondary Adrenal Insufficiency: A Case Report / 가정의학회지

Malakoplakia is an uncommon but distinctive type of chronic granulomatous inflammation that occurs most commonly in the genitourinary tract, especially the urinary bladder. Most patients have associated conditions characterized by some degree of immunosuppression, as seen in solid-organ transplants, autoimmune diseases requiring steroid use, chemotherapy, chronic systemic diseases, alcohol abuse and poorly controlled diabetes. We report an unusual case of the renal malakoplakia that involved the perirenal space, extending to the descending colon in a 65-year-old Korean woman with secondary adrenal insufficiency and diabetes mellitus.

Cytologic Findings of Malakoplakia of the Uterine Cervix and the Vagina: A Case Report / 대한세포병리학회지

Malakoplakia is an uncommon chronic granulomatous inflammation that usually involves the urinary and gastrointestinal tracts, but rarely affects the female genital tract. We experienced a case of malakoplakia in a cervicovaginal smear in a 54-year-old woman. Colposcopic examination showed a friable, easily bleeding tissue in the uterine cervix and the vaginal fornix. The cervicovaginal smear consisted of numerous isolated histiocytes, polymorphonuclear leukocytes, lymphocytes, and plasma cells. The histiocytes had an abundant, granular, and degenerated cytoplasm with inflammatory cell debris. Michaelis-Gutmann bodies were readily identified.

A Case of Malakoplakia Treated by Antibiotics in the Rectum / 대한소화기내시경학회지

Malakoplakia is a rare chronic inflammatory process, most commonly affecting the urinary tract. This entity was first described by Michaelis and Gutman in 1902. As of 1995, only 85 cases of malakoplakia of the gastrointestinal tract has been reported. The common sites of colonic involvement are the rectum, sigmoid, and right colon, in descending order of frequency. The most common disease associated with malakoplakia is colorectal carcinoma. Surgical resection is the treatement of choice for cases associated with carcinoma or complications. But in other cases, medical treatment could be attempted. Antimicrobial drugs, such as trimethoprime-sufamethoxazole, rifampin, or as recently suggested, ciprofloxacin can be used. We report a case of rectal malakoplakia treated by ciprofloxacin with a review of literatures.