Intramedullary Spinal Cord Malakoplakia Mimicking Malignant Neoplasm on 18F-FDG PET/CT.

ABSTRACT: We report a rare case of intramedullary spinal cord malakoplakia mimicking malignancy on 18F-FDG PET/CT. A 61-year-old man underwent a contrast-enhanced spinal cord MRI to evaluate 1 week of progressive left-sided weakness. Spinal cord MRI showed a 1.3-cm enhancing intramedullary cervical spinal cord mass at C5 level with cord edema. Subsequently, 18F-FDG PET/CT was performed for evaluation. The images showed a well-circumscribed hypermetabolic mass in the spinal cord; no lesions were suggestive of malignancy or metastasis. A subtotal tumor excision was performed; histopathological examination revealed malakoplakia. This emphasizes the significance of histopathological evaluation and the importance of diagnostic confirmation.

FDG-Avid Malakoplakia of the Ureter Mimicking Malignancy.

ABSTRACT: Malacoplakia is a rare chronic granulomatous disease and frequently associated with Escherichia coli infection. We describe the contrast-enhanced CT and FDG PET/CT findings in a case of bladder and ureteral malakoplakia with E. coli urinary tract infection. Contrast-enhanced CT showed multiple enhancing mural nodules in the bladder and left ureter, ranging from several millimeters to 3.1 cm. The ureteral nodules showed significantly increased FDG uptake with SUVmax of 20.4, due to histiocyte, lymphocyte, and plasma cell infiltrates revealed by histopathology.

18F-FDG PET/CT in a Patient With Epididymo-Testicular Malacoplakia.

ABSTRACT: A 56-year-old man presented with a 2-month history of a mass in the right epididymo-testicular region, which exhibited heterogeneous high avidity for 18F-FDG on PET/CT. Malignant tumor was highly suspected, leading to subsequent right orchiectomy and epididymectomy. Histopathological examination revealed the presence of characteristic Michaelis-Gutmann bodies within von Hansemann macrophages, confirming the diagnosis of malacoplakia.

Multiple-Organ Involvement of Malakoplakia Mimicking Malignant Neoplasms on 18 F-FDG PET/CT.

ABSTRACT: Abdominal contrast-enhanced CT was performed in a 61-year-old man with difficulties of urination and defecation for 4 months, which revealed huge rectal masses involving multiple adjacent organs, suspected as malignant lesions. 18 F-FDG PET/CT was subsequently performed for staging. The images showed intense FDG uptake and slightly hyperdense masses involving rectum, bladder, prostate, left ureter, and the anterior abdominal wall at the level of the pelvic cavity. Histopathological examination confirmed the masses were due to malakoplakia, which displayed as abundant von Hansemann cells aggregated and infiltrated in lesions, with distinctive cytoplasmic inclusions termed Michaelis-Gutmann bodies.

[A Case of Malacoplakia of the Prostate which was Difficult to Distinguish from Prostate Cancer].

A 70-year-old-man was referred with urination pain and pyuria. Prostate specific antigen was 10.6 ng/ml, and urine culture was Escherichia coli. The abdominal ultrasonography showed irregular low echo at the right lobe of prostate. Prostate magnetic resonance imaging (MRI) showed an extracapsular infiltrated prostate tumor in the right lobe. Levofloxacin was administered and prostate biopsy was performed. The pathological examination revealed that the prostate tissue was filled with inflammatory cells and had lost its glandular duct structure. The patient was diagnosed with malacoplakia of the prostate. Four months after prostate biopsy, prostate MRI imaging showed disappearance of the extracapsular infiltration in right peripheral zone.

CT and pathological features in renal parenchymal malakoplakia: a case report and review of the literature.

Renal malakoplakia is a rare form of chronic inflammatory granulomatous disease in the kidney. It occurs in adult patients with immunocompromised status or debilitating disease. In the present study, we reported a case of a 50-year-old woman with no underlying disease. This report describes the CT and pathological features of renal malakoplakia in a 50-year-old woman. Plain CT scan showed a large soft tissue mass at the middle and upper pole of the left kidney. Enhanced CT scan showed delayed enhancement in the solid part of the mass. Our results might provide some useful information for the diagnosis of renal parenchymal malakoplakia.

The necessity of transperineal ultrasound view in urethra malacoplakia.

This case illustrates the untypical presentation of primary bladder malacoplakia. The patient was in her mid-50s have impaired immunity by the long-term hyperglycemic condition. She presented with symptoms of urinary tract infection and dysuria, and had multiple nodulars in bladder and significantly mass in urethra. Although the diagnosis of bladder malacoplakia was established on bladder biopsy, transperineal ultrasound examination can find its distinct clinical presentation.

Malakoplakia and xanthogranulomatous pyelonephritis treated with nephrectomy: A case report.

RATIONALE: Malakoplakia and xanthogranulomatous pyelonephritis are chronic inflammatory conditions of the kidney characterized by the infiltration of inflammatory cells. PATIENT CONCERNS: An 82-year-old female patient had a history of hypertension, type 2 diabetes mellitus, dyslipidemia, and end-stage renal disease under hemodialysis. She was admitted repeatedly 4 times within 4 months due to urosepsis. DIAGNOSIS: The enlarged right kidney with a low-density lesion at the right middle calyx, and a well-enhanced ureter were noted on the computed tomography scan. Therefore, xanthogranulomatous inflammation was suspected. Semi-rigid ureteroscopy with biopsy was performed, and xanthogranulomatous inflammation of the ureter was confirmed on the pathology report. INTERVENTIONS: After right open radical nephrectomy was performed, the final pathology report revealed malakoplakia with xanthogranulomatous pyelonephritis. OUTCOMES: After the surgery, she has no longer suffered from urosepsis for 8 months, and there were no adverse event or recurrence noted. LESSONS: With this case report, we aim to emphasize that these 2 diseases are not mutually exclusive, but they may exist simultaneously in the same patient.

Malakoplakia Presenting as a Mass in the Transplanted Kidney: A Malignancy Mimicker on PET/CT.

Malakoplakia is a rare inflammatory condition that can affect many organ systems, including the genitourinary tract. It is associated with impaired immune function. Isolated renal parenchymal involvement has been reported in very few cases. Urinary tract and digestive malakoplakia have been reported in transplant recipients, but the involvement of transplant itself is rare. Variable clinical manifestations and nonspecific radiological appearance make the diagnosis difficult. The differential diagnosis includes infective etiologies and malignancy. We report a case of renal allograft malakoplakia, mimicking as a malignancy on F-FDG PET/CT.

Malakoplakia of the colon following renal transplantation in a 73 year old woman: report of a case presenting as intestinal perforation.

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.

Bladder Malakoplakia Simulating Neoplasm in a Young Girl: Report of a Case and Review of Literature.

Malakoplakia is a granulomatous disorder caused by infectious process. It was described by Von Hanseman in 1901 for the first time and then by Michaelis and Gutman in 1902.  Although the most frequent site of involvement is genitourinary tract, various organs have been reported to be affected. The peak age incidence is about 50 years and it is rare in childhood. In this paper we report a case of bladder malakoplakia which to our knowledge is the youngest with isolated bladder malakoplakia that has been reported.

Testicular malakoplakia: a rare sonographic mimic of malignancy.

Testicular malakoplakia is a rare, benign condition that most often occurs in an immunocompromised patient with chronic infection. Its occurrence is acute, with pain and testicular enlargement. Sonography is commonly performed to evaluate the patient for epididymitis or torsion. The appearance of testicular malakoplakia on sonography examination has only rarely been described, making its diagnosis challenging. Because its appearance overlaps with testicular neoplasm and infection, it should be considered when making a differential diagnosis of a diffuse testicular abnormality in the appropriate clinical setting.

[Malacoplakia of the seminal vesicles. Case report and particularities].

OBJECTIVE: Malacoplakia is a rare chronic granulomatous disorder that mostly affects the urogenital system. This article describes a case of uncommon location of this disease at the level of the seminal vesicles and the clinical, imaging and histological particularities of this medical entity. METHOD: We report the case of a 69 year-old male consulting for constitutional syndrome that presented a pelvic tumor on the image studies, possibly arising in the seminal vesicles. RESULTS: The diagnosis was made after performing transrectal ultrasound and seminal vesicles biopsy by the pathognomonic histological findings of Michaelis Gutmann bodies. The presence of E. Coli in urine culture in our patient justified the use of a long-term antibiotic therapy such as quinolones with very good results. CONCLUSION: Malacoplakia of the seminal vesicles is an extremely rare condition, sometimes with non-specific clinical presentation. Its diagnosis is histological and it has good response to prolonged antibiotic therapy with a benign outcome.