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Journal of Nuclear Medicine : Official... Aug 1998The purpose of this article is to review the potential role of nuclear medicine scanning, especially with 67Ga, in the presumptive diagnosis and clinical management of... (Review)
Review
UNLABELLED
The purpose of this article is to review the potential role of nuclear medicine scanning, especially with 67Ga, in the presumptive diagnosis and clinical management of patients with renal parenchymal malacoplakia (RPMP), a rare disease associated with coliform bacterial infection of the kidney and characterized by chronic unresolving inflammatory infiltrates containing von Hansemann macrophages in the renal parenchyma.
METHODS
Published cases of RPMP were collected from the archival literature by searching the MEDLINE database and by reviewing bibliographic references contained in articles on malacoplakia. Data on the clinical features and radiographic evaluation of patients with RPMP were extracted from the clinical case reports.
RESULTS
Forty-three cases of RPMP published over the past 20 yr were identified. Ten of the 43 patients (23%) had 67Ga scanning as a component of their diagnostic evaluation. In all 10 patients, renal uptake of 67Ga was classified as intense. Two of those 10 patients had serial 67Ga scanning performed to assess response to antibiotic treatment; both patients exhibited decreased uptake or complete resolution of abnormal renal uptake over time, a finding also exhibited by our patient.
CONCLUSION
Intense renal uptake of 67Ga, typically in the clinical setting of fever, progressive renal failure and nephromegaly, strongly supports a diagnosis of RPMP. In those patients receiving prolonged antimicrobial therapy for RPMP, resolution of abnormal 67Ga uptake over time may provide an objective endpoint for treatment.
Topics: Anti-Infective Agents; Ascorbic Acid; Ciprofloxacin; Citrates; Female; Gallium; Gallium Radioisotopes; Humans; Kidney Diseases; Malacoplakia; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Rifampin
PubMed: 9708528
DOI: No ID Found -
International Wound Journal Aug 2017Cutaneous malakoplakia is a rare infection-related granulomatous disease frequently associated with immunocompromised states. Foamy macrophages containing basophilic...
Cutaneous malakoplakia is a rare infection-related granulomatous disease frequently associated with immunocompromised states. Foamy macrophages containing basophilic granules, called the Michaelis-Gutman bodies, are pathognomonic. We report a case of cutaneous malakoplakia in a 77-year-old male with pyoderma gangrenosum and a 2-year history of a non-healing malleolar ulcer treated successfully with cotrimoxazole.
Topics: Administration, Cutaneous; Aged; Humans; Immunocompromised Host; Malacoplakia; Male; Pyoderma Gangrenosum; Treatment Outcome
PubMed: 27524799
DOI: 10.1111/iwj.12661 -
Diagnostic Pathology Jul 2020Malakoplakia is an uncommon, tumor-like inflammatory disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria. The...
BACKGROUND
Malakoplakia is an uncommon, tumor-like inflammatory disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria. The genitourinary tract is the most common site of involvement, however, cases have also been described in the gastrointestinal tract, suggesting that it is the second most common site of involvement. This study investigates the clinical and histologic features of malakoplakia in the gastrointestinal tract.
CASE PRESENTATION
For 23 gastrointestinal specimens (biopsies and resections) from patients with a pathologic diagnosis of malakoplakia, we recorded the gender, age, location, primary diagnosis, endoscopic or surgical indication, endoscopic/gross impression and immune status (immunocompromised vs. immunocompetent).
CONCLUSION
Malakoplakia occurred throughout the length of the gastrointestinal tract with most of the cases located in the sigmoid colon and rectum (n = 10); other sites included the transverse and descending colon (n = 4), stomach/gastroesophageal junction (n = 4), appendix (n = 2), cecum (n = 1), small bowel (n = 1), and the peri-anal area (n = 1). Endoscopically, these lesions most commonly appeared as polyps (n = 10) or masses (n = 5), other clinical endoscopic impressions varied from a thickened area/fibrosis to mucosal erythema. Most patients were immunocompromised due to a disease state (e.g. organ transplantation, cancer diagnosis, autoimmune condition) and/or medication effect. Eight patients with malakoplakia were on immunosuppressive medications (8/23, 35%). Common immunosuppressed disease states included cancer (n = 9), autoimmune disease (n = 5), status post organ transplantation (n = 4), diabetes (n = 5), infection/sepsis (n = 3), and HIV/AIDS (n = 1). Some patients had multiple co-morbidities (i.e. diabetes and organ transplant). Twenty-one patients with malakoplakia were in an immunosuppressive state (21/23, 91%).
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Child; Child, Preschool; Female; Gastrointestinal Tract; Humans; Immunocompromised Host; Immunosuppressive Agents; Malacoplakia; Male; Middle Aged; Rectum; Young Adult
PubMed: 32709245
DOI: 10.1186/s13000-020-01013-y -
Medicina Oral, Patologia Oral Y Cirugia... Jun 2008Malakoplakia is a relatively uncommon chronic inflammatory reaction of unknown etiology. It usually affects the genitourinary tract but may rarely involve the tongue.... (Review)
Review
Malakoplakia is a relatively uncommon chronic inflammatory reaction of unknown etiology. It usually affects the genitourinary tract but may rarely involve the tongue. There are many theories that explain this reaction but it seems to be the answer to an infectious agent in a patient with immunologic deficiency. Microscopically, malakoplakia is characterized by the presence of foamy histiocytes with distinctive basophilic inclusions, which are known as Michaelis-Gutmann bodies due to a partially ingested bacteria and their posterior calcification. There are many alternatives to treat this entity. We report the only case diagnosed in the tongue, in a 15 years-old male in the Maxillofacial Surgery and Stomatology Service of the Hospital San Vicente de Paúl in Medellín, Antioquia, Colombia.
Topics: Adolescent; Humans; Malacoplakia; Male; Tongue Diseases
PubMed: 18521054
DOI: No ID Found -
BMJ Case Reports Jul 2015Malakoplakia, a medical, surgical, pathological and radiological enigma, is an infrequent chronic inflammatory condition that can affect many organ systems, including... (Review)
Review
Malakoplakia, a medical, surgical, pathological and radiological enigma, is an infrequent chronic inflammatory condition that can affect many organ systems, including the gastrointestinal tract, integument, skeletal system and genitourinary tract. Review of the literature has shown that malakoplakia presents in paediatric as well as adult populations, and that it is associated with impaired immune function. Variable clinical manifestations as well as the sometimes non-specific radiological findings of malakoplakia can be misleading, making diagnosis quite difficult. We present a clinical case of renal malakoplakia mimicking a malignant renal carcinoma in a 62-year-old woman. This report highlights the importance of awareness of malakoplakia in the differential diagnosis for renal masses and renomegaly. This case can serve as a reminder that things are not always what they seem, and it reinforces the idea that unusual disease entities should be explored to aid in achieving a correct diagnosis and, thus, potentially avoid unnecessary treatment.
Topics: Carcinoma, Renal Cell; Diagnosis, Differential; Female; Humans; Kidney; Kidney Neoplasms; Malacoplakia; Middle Aged
PubMed: 26177998
DOI: 10.1136/bcr-2014-208652 -
Diagnostic Pathology Jul 2020Malacoplakia is a rare chronic inflammatory disease. The name derives from the Greek "μαλακός" meaning "soft" and "πλάξ" meaning "plaque", describing its...
BACKGROUND
Malacoplakia is a rare chronic inflammatory disease. The name derives from the Greek "μαλακός" meaning "soft" and "πλάξ" meaning "plaque", describing its usual macroscopic presentation as a friable yellow soft plaque. It was first described by von Hansemann in 1901 and by Michaelis and Gutmann in 1902. The urinary system is the most commonly involved site. Female genital tract involvement is extremely rare. Treatment is prevalently based on antibiotics with surgical intervention sometimes necessary. Prognosis is usually good, but relapse may frequently occur.
CASE PRESENTATION
This report illustrates the first case of endometrial malacoplakia in a 40 years-old patient who received endometrial curettage due to the retention of placental rests following an abortion. After conspicuous vaginal sero-hematic secretions, the patient received a further curettage. The histological examination did not show any retention of chorionic rests, but an endometrial and myometrial infiltration of histiocytes with large granular cytoplasm within a chronic inflammatory background. Immunoreactivity for CK-pool was negative, while CD68 immunostaining was strongly positive.
CONCLUSIONS
Malacoplakia of endometrium is an extremely rare condition, with few cases reported in the whole international literature. In this paper, we present the first case associated to an abortion followed by endometrial curettage procedures. This rare disease should always be attentively examined, considering, among differential diagnoses, uterine neoplasms or physiological conditions such as cumulus of foamy macrophages in the endometrium.
Topics: Abortion, Induced; Adult; Dilatation and Curettage; Endometrium; Female; Humans; Malacoplakia; Pregnancy
PubMed: 32682433
DOI: 10.1186/s13000-020-01014-x -
Diagnostic Pathology Mar 2019Malakoplakia is a chronic inflammatory disease characterized by tissue infiltrates of large granular macrophages containing distinctive intracytoplasmic inclusions... (Review)
Review
BACKGROUND
Malakoplakia is a chronic inflammatory disease characterized by tissue infiltrates of large granular macrophages containing distinctive intracytoplasmic inclusions termed Michaelis-Gutmann (MG) bodies. The genitourinary system is the most commonly involved site, followed by the gastrointestinal tract. Malakoplakia may occur as a complication of primary or secondary immunosuppression and, therefore, renal transplant recipients are at risk. The graft itself or extra-renal sites may be involved. Regarding the latter, six cases of colorectal malakoplakia have been reported following renal transplantation, with all but one patient experiencing significant morbidity. We describe a further example of colorectal malakoplakia following renal transplantation. The other previously reported cases are reviewed.
CASE PRESENTATION
A 72 year old female presented with left lower quadrant abdominal pain and vaginal bleeding. She had received a cadaveric renal transplant for chronic renal failure ten months previously. Abdomino-pelvic computerized tomography (CT) scanning demonstrated two lesions in the mesocolon: the first adjacent to the descending colon and the second involving the sigmoid colon. A diagnosis of sub-acute perforated diverticulitis with two phlegmons was proposed. The sigmoid lesion was resected. The descending colon lesion was treated by creation of a cutaneous fistula. Microscopy of the sigmoid lesion showed the typical features of malakoplakia. She was discharged on sulfamethoxazole-trimethoprim. Nine months later, no longer receiving antibiotic therapy, the patient reported lower left quadrant discomfort. CT scanning showed para-rectal and pelvic abdominal masses with cutaneous and intestinal fistulas. Treatment with tazobactam-piperacillin was begun and sulfamethoxazole-trimethoprim was reinstated, with subsequent slow clinical improvement. Subsequent abdominal CT scans have shown persistence of the lesions.
CONCLUSIONS
Physicians caring for renal transplant recipients should be aware of colorectal malakoplakia as a rare but serious complication. The onset may be within months or as long as a decade or more following transplantation. The clinical presentation is varied, nonspecific, and will likely suggest more common diseases. Although radiologic imaging is also nonspecific, awareness of malakoplakia is of importance to radiologists when formulating the differential diagnosis of mass lesions of the colorectum in this clinical setting. Definitive diagnosis remains dependent on pathologic examination of a biopsy or surgical resection specimen.
Topics: Aged; Anti-Bacterial Agents; Biopsy; Colon; Cutaneous Fistula; Female; Humans; Immunosuppressive Agents; Intestinal Perforation; Kidney Transplantation; Malacoplakia; Rectum; Tomography, X-Ray Computed
PubMed: 30866984
DOI: 10.1186/s13000-019-0799-z -
Medicine Jun 2020Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from...
RATIONALE
Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from malignance and results in severe lower urinary tract symptoms. The malacoplakia combined with XC is even rarer in the literature.
PATIENT CONCERNS
A 64-year-old female, who presented with nocturia, frequency of micturition, severe urgency with occasional urinary incontinence, and recurrent hematuria for >2 years, was diagnosed with azotemia and anemia. In addition, two 1.0 × 1.0 cm masses of bladder were detected by computer tomography.
DIAGNOSES
Malacoplakia combined with xanthogranulomas cystitis was diagnosed histologically. Video urodynamic test showed poor bladder compliance (9 mL/comH2O), markedly decreased maximum bladder capacity (120 mL), and right vesicoureteral reflux at a low intravesical pressure level (25 cmH2O).
INTERVENTIONS
Transurethral resection of bladder masses was carried out after treatment of urinary infection by intravenous piperacillin-tazobactam. Oral Ciprofloxacin and Tolterodine were postoperatively used to prevent recurrent lower urinary tract infections and alleviate detrusor overactivity.
OUTCOMES
The treatment did not alleviate azotemia, frequency, urgency with incontinence, and bilateral hydroureteronephrosis, but the patient refused to undergo bladder augmentation on account of her poor economic status.
LESSONS
Malacoplakia or/and xanthogranulomas cystitis may lead to poor bladder compliance and video urodynamic study should be considered in patients with refractory chronic lower urinary tract symptoms.
Topics: Cystitis; Female; Humans; Malacoplakia; Middle Aged; Nocturia; Tomography, X-Ray Computed; Urinary Bladder; Urinary Incontinence; Urinary Tract Infections
PubMed: 32590783
DOI: 10.1097/MD.0000000000020852 -
Dermatology Online Journal Jan 2010Malakoplakia is an uncommon inflammatory condition usually affecting the genitourinary tract, which has been associated with infections, tumors, and immunocompromised... (Review)
Review
Malakoplakia is an uncommon inflammatory condition usually affecting the genitourinary tract, which has been associated with infections, tumors, and immunocompromised states. The condition has been reported in many different organs and it may rarely involve the skin. We describe a case of an isolated perianal cutaneous malakoplakia in an immunocompetent 23-year-old Syrian male.
Topics: Anti-Bacterial Agents; Anus Diseases; Anus Neoplasms; Ascorbic Acid; Ciprofloxacin; Combined Modality Therapy; Condylomata Acuminata; Diagnostic Errors; Drug Therapy, Combination; Humans; Immunocompetence; Macrophages; Malacoplakia; Male; Recurrence; Young Adult
PubMed: 20137752
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Mar 2005We report a case of malacoplakia in the ureter and bladder. A 78-year-old woman was admitted to our department for detailed examination of hydronephrosis. A...
We report a case of malacoplakia in the ureter and bladder. A 78-year-old woman was admitted to our department for detailed examination of hydronephrosis. A small-fingertip-sized tumorous yellowish white lesion was detected by cytoscopy at a site that appeared to be the right side of the ureteral orifice. Transurethral resection was performed on the same site. Flat yellowish white protruding lesions were seen at two sites on the right ureter. Michaelis-Gutmann bodies were observed in biopsy specimens from both the bladder and ureter, and a diagnosis of malacoplakia was made. Ascorbic acid and bethanechol chloride were administered postoperatively. Endoscopy performed three months after the operation showed that the protruding lesions in the bladder and ureter had disappeared. Narrowing of the ureter or vesicoureteral reflux has not been seen to date.
Topics: Aged; Ascorbic Acid; Bethanechol Compounds; Drug Therapy, Combination; Female; Humans; Hydronephrosis; Malacoplakia; Ureteral Diseases; Urinary Bladder Diseases
PubMed: 15852673
DOI: No ID Found