RESUMO
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.
Assuntos
Fluordesoxiglucose F18 , Malacoplasia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Medula Espinal , Humanos , Masculino , Pessoa de Meia-Idade , Diagnóstico Diferencial , Neoplasias da Medula Espinal/diagnóstico por imagem , Malacoplasia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Imagem Multimodal , Tomografia por Emissão de PósitronsRESUMO
Malakoplakia is a rare granulomatous, chronic inflammatory disease generally affecting the urogenital organs, though it can arise in other organs. The clinical manifestations of malakoplakia vary depending on the affected organ. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies on pathology. This report describes a case of pelvic malakoplakia accompanied by an ovarian tumour-cutaneous fistula, initially misdiagnosed as advanced ovarian cancer invading the anterior abdominal wall with left pleural effusion based on imaging studies and increased serum carbohydrate antigen 19-9. The patient underwent left thoracentesis and fluid collection from the fistula tract for cytology, which showed no malignancy. She underwent primary debulking surgery, including removal of the fistula tract from anterior abdominal wall. Histopathological examination revealed malakoplakia coexisting with mucinous cystadenoma of the left ovary. For postoperative management, she received prolonged oral antibiotics for 6 months. There was no evidence of disease recurrence at the 24-month follow-up.
Assuntos
Fístula Cutânea , Malacoplasia , Neoplasias Ovarianas , Humanos , Feminino , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Malacoplasia/diagnóstico , Malacoplasia/complicações , Diagnóstico Diferencial , Fístula Cutânea/diagnóstico , Fístula Cutânea/etiologia , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/complicações , Cistadenoma Mucinoso/cirurgia , Pessoa de Meia-Idade , PelveRESUMO
Malakoplakia is a rare inflammatory disorder believed to result from a defect in macrophage phagocytic function triggering a granulomatous reaction. It can present with genitourinary, gastrointestinal, or cutaneous manifestations in immunocompromised or, less commonly, immunocompetent hosts. We describe a case of renal malakoplakia in a young, otherwise healthy patient presenting with nephromegaly and sepsis following an E. coli urinary tract infection. We discuss diagnosis and management, including antibiotic selection and the decision to pursue nephrectomy. This case highlights the potential for kidney recovery with prolonged antibiotic therapy in conjunction with adjunct immunomodulatory therapies and source control.
Assuntos
Infecções por Escherichia coli , Malacoplasia , Infecções Urinárias , Humanos , Malacoplasia/complicações , Malacoplasia/etiologia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções por Escherichia coli/complicações , Masculino , Antibacterianos/uso terapêutico , Adulto , Feminino , Escherichia coli/isolamento & purificaçãoRESUMO
Malakoplakia is a rare inflammatory disorder which typically occurs in immunocompromised patients secondary to impaired bactericidal activity of macrophages. While this entity commonly arises in the genitourinary and gastrointestinal tracts, lesions of the head and neck have been reported only rarely, with oral cavity involvement reported in 3 cases. The most common presentation of head and neck malakoplakia is that of a cutaneous flesh-colored papule or nodule. This case report, however, illustrates the first time malakoplakia is identified affecting the maxilla and maxillary alveolar ridge mucosa. Histochemical and immunohistochemical stains are presented and include positivity for PAS, von Kossa stain, iron stain, and CD68 and negativity for GMS and Gram stains, indicating an inability to demonstrate microbial infection. Thus, clinicians and pathologists alike should be aware of malakoplakia as a pathologic entity when forming differential diagnoses, particularly in immunosuppressed individuals.
Assuntos
Malacoplasia , Humanos , Malacoplasia/patologia , Malacoplasia/diagnósticoRESUMO
Ocular malakoplakia, a rare inflammatory disorder characterized by Michaelis-Gutmann bodies, is presented in 2 unique cases involving uncommon anatomical sites-the orbit and caruncle. The first case describes a 10-year-old girl with localized subconjunctival swelling near the caruncle, prompting surgical excision, and revealing characteristic malakoplakia features. Despite medical management, surgical intervention provided symptom relief. The second case involves a painless swelling below the lower lid in a 23-year-old female, initially suggestive of lymphoma. Excision biopsy confirmed malakoplakia, emphasizing the potential for clinical misdiagnosis. Histopathological examination showcased Michaelis-Gutmann bodies, von Hansemann cells, and chronic inflammation, confirming the ocular malakoplakia diagnosis. These cases underscore the rarity of ocular malakoplakia, particularly in pediatric patients, and highlight the importance of accurate diagnosis and appropriate management.
Assuntos
Malacoplasia , Humanos , Feminino , Criança , Malacoplasia/diagnóstico , Malacoplasia/cirurgia , Adulto Jovem , Procedimentos Cirúrgicos Oftalmológicos/métodos , Biópsia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/cirurgiaAssuntos
Nefropatias , Transplante de Rim , Malacoplasia , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Malacoplasia/complicações , Malacoplasia/diagnóstico , Malacoplasia/diagnóstico por imagem , Malacoplasia/patologia , Nefropatias/diagnóstico , Nefropatias/diagnóstico por imagem , Nefropatias/patologiaRESUMO
BACKGROUND: Malakoplakia is a rare chronic granulomatous disease characterized by the presence of Michaelis-Gutmann bodies (MGBs) within histiocytic aggregates. It predominantly affects immunocompromised individuals, including those living with Human Immunodeficiency Virus (HIV). CASE PRESENTATION: We present a unique case of bifocal malakoplakia in a 49-year-old man, previously with Coronavirus disease 2019 (COVID-19) and HIV positive, presented with respiratory symptoms, weight loss, and lymphadenopathy. He had various infections including Non-Tuberculous Mycobacteria (NTM), Cytomegalovirus (CMV), and Candida, with evolving lung and gastrointestinal issues. Despite treatment attempts, he deteriorated due to respiratory distress, multi-organ failure, and coagulopathy, leading to his unfortunate demise. CONCLUSION: This report presents a distinctive and complex case of malakoplakia in an HIV-positive patient, a rare inflammatory disorder originally described by Michaelis and Gutmann in 1902. The hallmark Michaelis-Gutmann organisms were observed, confirming the diagnosis. While typically affecting the urinary tract, this case demonstrates the exceptional ability of malakoplakia to manifest in various organ systems, including pulmonary, gastrointestinal, and more. Although Escherichia coli is a prevalent associated pathogen, the exact cause remains elusive. Treatment, often involving surgical excision and antibiotic therapy, underscores the challenging nature of managing this condition in immunocompromised individuals.
Assuntos
COVID-19 , Infecções por HIV , Soropositividade para HIV , Malacoplasia , Masculino , Humanos , Pessoa de Meia-Idade , HIV , Infecções por HIV/complicações , COVID-19/complicaçõesRESUMO
Malakoplakia is a rare granulomatous disease. Its aetiology is unclear but possible theories include infection with microorganisms (especially Escherichia coli), immunosuppression and impaired lysosomal function. It has been commonly documented to affect the genitourinary tract but can affect any organ, with the gastrointestinal system being the next most affected. We present a woman in her 70s, with a 2-week history of right-sided abdominal pain, 13 years following her renal transplant. She was admitted for treatment of an E. coli bacteraemia. CT scan had shown a caecal pole mass, highly suspicious for malignancy. It was surgically resected, and histology revealed findings of malakoplakia within the colon. Surgical intervention was combined with a prolonged course of antibiotics for successful treatment. We highlight the ability of malakoplakia to mimic malignancy and should be considered in the differentials in the context of an immunosuppressed patient with radiological findings of a colonic mass.
Assuntos
Neoplasias do Colo , Malacoplasia , Feminino , Humanos , Escherichia coli , Ceco , Doenças RarasRESUMO
OBJECTIVE: This study aims to explore the clinical diagnosis and treatment methods of bladder malakoplakia (MUB) to enhance the understanding of the disease. METHODS: A retrospective analysis of the diagnosis and treatment processes of three cases of MUB treated in our department was conducted. Relevant literature from both domestic and international sources was reviewed to provide a comprehensive analysis. RESULTS: All three patients underwent transurethral resection of bladder lesions combined with antibiotic therapy, and two of them received transurethral instillation of gemcitabine. There were two cases with two recurrences each, and one case with four recurrences, with the latter also concurrently presenting with unilateral ureteral malakoplakia. Postoperative pathology confirmed MUB in all three cases. Close follow-up revealed no significant recurrence in the patients. CONCLUSION: The effective diagnosis rate is increased by conducting multiple deep, repetitive, and randomly selected live tissue examinations. The definitive diagnosis of MUB relies on pathological histological examination. Treatment involving a combination of antibiotics and transurethral resection of bladder lesions proves to be effective. Exploring the use of bladder instillation of gemcitabine widens the spectrum of MUB treatment methods.
Assuntos
Malacoplasia , Humanos , Malacoplasia/patologia , Malacoplasia/diagnóstico , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Doenças da Bexiga Urinária , Antibacterianos/uso terapêutico , Gencitabina , Estudos Retrospectivos , Desoxicitidina/análogos & derivados , Desoxicitidina/administração & dosagem , Desoxicitidina/uso terapêuticoAssuntos
Malacoplasia , Protectomia , Neoplasias Retais , Humanos , Malacoplasia/diagnóstico , Malacoplasia/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Pelve/patologia , Períneo/cirurgia , Períneo/patologia , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Complicações Pós-OperatóriasRESUMO
Malakoplakia is a chronic granulomatous condition that has been rarely seen affecting the prostate. Isolated malakoplakia of the prostate occurring together with prostatic adenocarcinoma is rarer still with only 9 previously recorded cases. We present a case diagnosed through needle biopsy with prostatic adenocarcinoma and then on subsequent prostatectomy was diagnosed with extensive malakoplakia occurring with the carcinoma. Patient was noted to have a urinary tract infection (UTI) 2 weeks after needle biopsy and notably, 4 of the 9 previously reported cases also presented with UTI following their biopsies. The theory that prostatic malakoplakia may be a complication of the prostate needle biopsy is logically possible, but due to the paucity in cases, it is difficult to infer causality.
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Adenocarcinoma , Malacoplasia , Doenças Prostáticas , Neoplasias da Próstata , Masculino , Humanos , Próstata/patologia , Doenças Prostáticas/complicações , Doenças Prostáticas/diagnóstico , Doenças Prostáticas/patologia , Malacoplasia/complicações , Malacoplasia/diagnóstico , Malacoplasia/patologia , Neoplasias da Próstata/complicações , Neoplasias da Próstata/patologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologiaAssuntos
Injúria Renal Aguda , Malacoplasia , Infecções Urinárias , Humanos , Malacoplasia/complicações , Malacoplasia/diagnóstico , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologiaAssuntos
Hidronefrose , Transplante de Rim , Malacoplasia , Humanos , Transplante de Rim/efeitos adversos , Malacoplasia/tratamento farmacológico , Malacoplasia/etiologia , Antibacterianos/uso terapêutico , Terapia de Imunossupressão/efeitos adversos , Hidronefrose/complicações , Hidronefrose/tratamento farmacológicoRESUMO
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.
Assuntos
Malacoplasia , Ureter , Neoplasias Ureterais , Humanos , Ureter/diagnóstico por imagem , Fluordesoxiglucose F18 , Malacoplasia/diagnóstico por imagem , Escherichia coli , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaRESUMO
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.
Assuntos
Fluordesoxiglucose F18 , Malacoplasia , Masculino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Malacoplasia/diagnóstico por imagem , Testículo/diagnóstico por imagem , Tomografia por Emissão de PósitronsRESUMO
BACKGROUND: Malakoplakia is a rare inflammatory disease of the urogenital tract. There have been no reports of malakoplakia expressing anaplastic lymphoma kinase (ALK) to date. Here, we present one case of malakoplakia with aberrant ALK expression by immunohistochemistry and discuss the clinical significance. CASE PRESENTATION: A 65-year-old Chinese woman with a history of diabetes presented with solid masses in the liver and kidney and elevated lesions on the mucosal surface of the colon. Right nephrectomy and partial liver resection were performed. Microscopically, sheets of histiocytes with poor intercellular adhesion were seen, with Michaelis-Gutmann bodies present in both the intracellular and extracellular interstitium. CD10-, CD68-, and CD163-positive cells were present, with Michaelis-Gutmann bodies confirmed by staining with Alcian blue, periodic acid-Schiff (PAS), periodic acid-Schiff with diastase, Von Kossa, and Prussian blue. Aberrant ALK1 and ALK (D5F3) expression was observed in the cytoplasm and nucleus of cells. However, ALK gene mutation was not detected by fluorescence in situ hybridization or whole exome next-generation sequencing. NGS revealed nine individual somatic gene mutations: GOT1L1, GLIS2, SPOUT1, TMEM97, MUC3A, NSD2, SFXN5, ADAD1 and RAD50. The significance of the somatic gene mutations detected in this study is not clear, and the relationship between them and malakoplakia cannot be clarified by existing scientific studies. The pathological diagnosis was malakoplakia with aberrant ALK expression by immunohistochemistry. The antibiotics imipenem and vancomycin were started based on the results of drug sensitivity analysis and the patient was subsequently discharged. She experienced no discomfort during 30 months of follow-up. CONCLUSION: This is the first reported case of malakoplakia with aberrant ALK expression, it should be differentiated from ALK-positive histiocytosis to avoid misdiagnosis.
Assuntos
Malacoplasia , Feminino , Humanos , Idoso , Quinase do Linfoma Anaplásico , Imuno-Histoquímica , Malacoplasia/diagnóstico , Hibridização in Situ Fluorescente , Ácido PeriódicoRESUMO
Malakoplakia is a rare chronic granulomatous disease usually affecting the urinary bladder and other locations. In humans, the gastrointestinal tract is the second most common location but there are no reports of intestinal malakoplakia in animals. A 10-month-old female French Bulldog was presented with chronic haemorrhagic diarrhoea and anorexia with normochromic-normocytic anaemia and hypoalbuminaemia. Grossly, there was mucosal thickening and ulceration of the caecum, colon and rectum. Microscopically, transmural sheets of foamy macrophages were seen in these tissues. Macrophages were periodic acid-Schiff, vimentin and ionized calcium-binding adaptor molecule 1 positive and contained von Kossa- and Prussian blue-positive Michaelis-Gutmann bodies. Giemsa staining revealed rod-shaped bacterial colonies and fluorescence in-situ hybridization demonstrated Escherichia coli within macrophages. This is the first reported case of intestinal malakoplakia in domestic animals. Pathological features of intestinal malakoplakia share many similarities with ulcerative histiocytic colitis in dogs but it is unclear if they are different forms of the same pathological process or distinct entities.
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Colite Ulcerativa , Doenças do Cão , Malacoplasia , Humanos , Animais , Cães , Feminino , Malacoplasia/veterinária , Intestinos , Colite Ulcerativa/veterináriaRESUMO
A 3-month-old female French Bulldog presented with hematuria, severe pollakiuria, and urinary incontinence lasting for 1.5 months. Broad-spectrum empirical antibiotic therapy and nonsteroidal anti-inflammatory drugs were initiated by the referring veterinarian. Due to a lack of improvement, the dog was referred. At referral examination, urinary clinical signs persisted (hematuria, severe pollakiuria) and a firm bladder was noted. Abdominal ultrasonography revealed severe, diffuse bladder wall thickening with a significant reduction in the bladder lumen. Urinary tract endoscopy showed whitish exophytic proliferations throughout the entire bladder wall. Histological bladder wall analysis led to a diagnosis of bladder malakoplakia. Prolonged antibiotic therapy with fluoroquinolones was prescribed and resulted in clinical remission despite persistent bacteria in the bladder wall. This report describes a case of successfully medically managed bladder malakoplakia, a very rare condition in veterinary medicine, well documented in humans.