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 Involving the Maxilla: A Case Report and a Review of the Literature.

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.

Tracking Endometrial Malacoplakia Through the Evolution of 2D and 3D Ultrasound and Histopathological Features.

Malacoplakia is an uncommon disease characterized by chronic and granulomatous inflammation, which rarely involves the female genital tract. We describe the ecographic and histological evolution of the first case of a patient developing endometrial malacoplakia as a complication after a cesarean section. The patient, a 43-year-old woman, presented with pelvic pain one month after delivering by cesarean section and the initial suspicion was of retention of placental rests. We discuss the diagnostic challenges for this rare disease, highlighting the importance of considering endometrial malacoplakia as a possible diagnosis in patients with similar clinical presentations and the important role of 2D and 3D ultrasound in the diagnostic pathway. In literature, ultrasound findings in cases of endometrial malacoplakia are represented by hypoechoic thickening of the endometrial lining; hyperechoic thickening of the myometrium, and the presence of masses, nodules, cystic areas, or anechoic fluid within the endometrium. For the first time, we describe the evolution of endometrial malacoplakia through both ultrasound, 2D and 3D, and histopathological findings, from the acute to chronic stage of the disease.

Case report: A rare case of malacoplakia resembling a malignant tumor of the cervix: a case report and review of the literature.

Malacoplakia is a rare chronic granulomatous disease that mostly affects the gastrointestinal tract and urinary tract of immunocompromised patients; malacoplakia rarely effects the female reproductive tract. Here, we report a 56-year-old patient who underwent thymectomy for thymoma and myasthenia gravis prior to developing cervical and vaginal malacoplakia. The patient presented with recurrent vaginal bleeding. We discovered that there were alterations in the cervical cauliflower pattern during colposcopy, which is suggestive of cervical cancer. Pathological examination of the lesion tissue showed that a large number of macrophages aggregated, and M-G bodies with concentric circles and refractive properties were observed between cells. Immunostaining for CD68 and CD163 was positive, and special staining for D-PAS and PAS was positive. The discovery of Escherichia coli in bacterial culture can aid in the diagnosis of malacoplakia. Following surgery, we performed vaginal lavage with antibiotics in addition to resection of local cervical and vaginal lesions. This study provides a fresh perspective on the management of genital malacoplakia.

Malacoplakia of the bladder combined with infected renal calculi: A case report.

Introduction: The malacoplakia of the bladder is a rare chronic acquired infection- associated granulomatous disease and even less common in combination with urinary stones. Case Presentation: We report the case of a 58-year-old female patient with malacoplakia of the bladder combined with renal calculi. The patient was admitted to the hospital with bilateral low back pain for one month and space-occupying lesions of the bladder for three days. Preoperative imaging suggested space-occupying lesions of the bladder: high probability of bladder cancer. Following the anti-infection treatment, the transurethral electrodesiccation was performed on the space-occupying lesions of the bladder. Pathological examination confirmed the diagnosis of malacoplakia of the bladder. Left-sided percutaneous nephrolithotomy was performed electively to remove the predisposing factors of infection. After the operation, the patient continued to receive anti-infection treatment for two months. The patient had a good prognosis in the six-month follow-up. Conclusions: Malacoplakia of the bladder is easily misdiagnosed as bladder cancer before operation, and the diagnosis depends on pathological diagnosis. Complete removal of urinary calculi, infection and other inducing factors, is beneficial to the treatment of malacoplakia of the bladder.

Bladder malacoplakia: A case report.

BACKGROUND: Bladder malacoplakia is a rare chronic granulomatous disease. The most common site of the malacoplakia is the urinary system. The etiology of bladder malacoplakia is complex, with its clinical misdiagnosis rate is high. Therefore, exposure to more clinical cases is necessary to improve the diagnosis and treatment of this condition. CASE SUMMARY: A 65-year-old woman was admitted to our hospital because of dysuria. She presented with dysuria, frequent urination, urgency, pain, and absence of hematuria and pyuria. After the examination, bladder tumor electrocision was performed under combined intravenous and inhalation anesthesia on September 6, 2021. During the operation, electrotomy and electrocoagulation were performed. The operation was then followed by anti-infection treatment, and the patient recovered well. The postoperative pathology was diagnosed as bladder malacoplakia by light and electron microscopic analyses. On a follow-up after 4 mo, no significant difference between electrotomy and electrocoagulation was found, with both achieving a curative effect. CONCLUSION: Diagnosing bladder malacoplakia depends on histopathological examination. Antibiotic treatment with bladder tumor resection or electrocoagulation provides better therapeutic effect.

Malacoplakia of the Uterine Cervix: A Case Report.

Malacoplakia is an uncommon chronic granulomatous inflammation that rarely affects the female genital tract. A case of a 78-year-old woman with malacoplakia involving the uterine cervix and the vagina is described. The patient complained of vaginal bleeding. Clinically, a 13-mm mass was detected in the cervix, which was confirmed by ultrasound scan and magnetic resonance imaging. Histological examination showed a dense histiocytic infiltrate with abundant Michaelis-Gutmann bodies involving the uterine cervix and the upper vagina. The presence of Escherichia coli was confirmed in the lesion by immunohistochemistry and polymerase chain reaction. Only 12 cases of cervical malacoplakia have been reported to date. This condition should be included in the differential diagnosis of cervical tumors.

Case Report: Malacoplakia Due to E. coli With Cryptococcus albidus Infection of a Transplanted Kidney in a Patient With Recurrent Urinary Tract Infection.

Background: Colonization of Cryptococcus rarely occurs in a graft. This study reports a case of malacoplakia and cryptococcoma caused by E. coli and Cryptococcus albidus in a transplanted kidney, with detailed pathology and metagenome sequencing analysis. Case Presentation: We presented a case of cryptococcoma and malacoplakia in the genitourinary system including the transplant kidney, bladder, prostate, and seminal vesicles caused by Cryptococcus albidus and Escherichia coli in a renal-transplant recipient. Metagenome sequencing was conducted on a series of samples obtained from the patient at three different time points, which we termed Phase I (at the diagnosis of cryptococcoma), Phase II (during perioperative period of graftectomy, 3 months after the diagnosis), and Phase III (2 months after graftectomy). Sequencing study in the Phase I detected two and four sequences of C. albidus respectively in cerebrospinal fluid (CSF) and feces, with resistant Escherichia coli 09-02E presented in urine and renal mass. A 3-month antibiotic treatment yielded a smaller bladder lesion but an enlarged allograft lesion, leading to a nephrectomy. In the Phase II, two sequences of C. albidus were detected in CSF, while the E. coli 09-02E continued as before. In the Phase III, the lesions were generally reduced, with one C. albidus sequence in feces only. Conclusions: The existence and clearance of Cryptococcus sequences in CSF without central nervous system symptoms may be related to the distribution of infection foci in vivo, the microbial load, and the body's immunity. Overall, this study highlights the need for enhanced vigilance against uncommon types of Cryptococcus infections in immunocompromised populations and increased concern about the potential correlation between E. coli and Cryptococcus infections.

Unexpected endometrial malacoplakia related to abortion and placental rests retention: a case report.

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.

Bilateral hydroureteronephrosis with renal failure caused by malacoplakia.

INTRODUCTION: Malacoplakia is a rare chronic inflammatory disease that most commonly involves the genitourinary tract with a wide spectrum of clinical presentation. CASE DESCRIPTION: A 65-year-old woman presented with obstructive nephropathy with bilateral hydroureteronephrosis. Bilateral nephrostomy-tube placement saw an improvement in her renal function. A computerized tomography (CT) scan with contrast showed suspect lesions in the bladder, which were confirmed by cystoscopy. A transurethral resection of the suspect areas of bladder on histological examination confirmed the diagnosis of malacoplakia. Bilateral ureteral recanalization was performed with placement of ureteral stents, after balloon dilation of strictures. The treatment was continued with ascorbic acid 500 mg daily and ciprofloxacin 500 mg once daily. CONCLUSIONS: Malacoplakia is a rare disease. Treatment is not standard and depends on the disease location. Malacoplakia that is isolated to the lower genitourinary tract, after a transurethral resection indicating to obtain a biopsy and debulking, can typically be treated with medication, whereas upper tract disease commonly requires a combination of medical and surgical intervention.

Malacoplaquia del colon: Rara enfermedad que puede presentarse como un sindrome consuntivo

La malacoplaquia del colon es una causa inusual de diarrea crónica y puede presentarse como una enfermedad consuntiva. A nivel de colon produce lesiones ulceradas y nodulares erosionadas, similares a las de otras enfermedades infecciosas o granulomatosas más comunes. El diagnostico se basa en el estudio anatomopatológico que muestra acúmulos de histiocitos en la lámina propia, en cuyo interior se observan unas inclusiones redondeadas, positivas a la tinción de Von Kossa, denominadas cuerpos de Michaelis-Gutmann. Presentamos el caso de un varón 55 años, sin otras enfermedades asociadas, que debutó con diarrea, baja ponderal y anemia, mostrando una respuesta clínica muy favorable con el uso de antibióticos.

Colonic malacoplakia is an unusual cause of chronic diarrhea, and it may present as a consumptive disease. At the colon, it can induce ulcerative and erosive nodular lesions, that mimic other common granulomatous or infectious diseases. Diagnosis is support in biopsies showing groups of histiocytes, with typical Michaelis-Gutmann inclusions, which are positive with the Von Kossa stain. We present the case of a 55-year-old male, without associated diseases, who presented with diarrhea, weight loss and anemia, showing a very good clinical response to antibiotics.

Malacoplaquia en un adolescente: a propósito de un caso / Malacoplakia in a teenager: A case report

Resumen La malacoplaquia es una enfermedad inflamatoria rara, granulomatosa y crónica, caracterizada por infiltrados agregados de histiocitos conocidos como inclusiones de Michaelis-Gutmann. El sistema urinario es el sitio afectado más común, seguido del tracto gastrointestinal. El pronóstico de la enfermedad depende de la extensión, la localización y la salud subyacente del paciente. Caso: se describe un caso clínico de un paciente masculino de 15 años de edad, sin antecedentes de salud de importancia, que inicialmente presenta la enfermedad a partir de los 7 años con hematoquecia y dolor abdominal de leve intensidad que mejoraba después de la defecación. Se realizó una colonoscopia en la que se visualizaron lesiones pseudopolipoideas en el colon sigmoide, las cuales fueron biopsiadas y reportaron pólipos inflamatorios con focos de agudización, numerosos histiocitos (cuerpos de Michaelis-Gutmann) y cambios reactivos del epitelio que diagnosticaron malacoplaquia. Conclusión: la malacoplaquia es una enfermedad muy rara en personas jóvenes sin enfermedad subyacente. Su prevalencia es desconocida, pero se han descrito más de 700 casos. Puede darse en todas las edades, con edad media al diagnóstico de 50 años. Los casos pediátricos son raros. Existe una mayor incidencia en hombres y no tiene predilección por la raza. El 60% a 80% de los casos afecta al tracto urinario (vejiga, riñones y uretra); el 15%, al tracto digestivo (colon izquierdo, sigma, recto y estómago); y en menor porcentaje, otras zonas menos frecuentes como piel, pulmones y sistema nervioso central. El pronóstico de la enfermedad es generalmente bueno. Presentamos un caso de un joven sano de 15 años de edad sin enfermedad asociada evidente, que ilustra la rareza de esta presentación y la necesidad de un alto nivel de sospecha clínica para diagnosticar la enfermedad.

Abstract Malacoplakia is a rare, granulomatous, chronic inflammatory disease characterized by foamy histiocytic infiltrations known as Michaelis-Gutmann inclusions. The urinary system is the most commonly affected site, followed by the gastrointestinal tract. The prognosis of the disease depends on the extent, location, and underlying health status of the patient. This is the clinical case of a 15-year-old male patient with no significant health history. At age 7, the patient presented with hematochezia and mild abdominal pain that improved after defecation. A colonoscopy was performed, finding pseudopolypoid lesions in the sigmoid colon. Biopsy samples were taken, and the report showed inflammatory polyps with exacerbation foci, numerous histiocytes (Michaelis-Gutmann bodies), and reactive epithelial changes that lead to diagnose malacoplakia. Conclusion: Malacoplakia is a very rare disease in young people with no underlying disease. Its prevalence is unknown, but more than 700 cases have been reported. It can occur at all ages, with a mean age at diagnosis of 50 years. Pediatric cases are rare. There is a higher incidence in men, and it has no racial predilection. Between 60% and 80% of cases involve the urinary tract (bladder, kidneys, and urethra); 15% involve the digestive tract (left colon, sigmoid colon, rectum, and stomach); and, to a lesser extent, other areas such as skin, lungs, and central nervous system may be affected. The prognosis of the disease is usually good. This is the case of a healthy 15-year-old male with no apparent associated disease that illustrates the rarity of this presentation and the need for a high level of clinical suspicion to diagnose the disease.

A Case of Urachal Malacoplakia that Seems Like Urachal Cancer.

BACKGROUND: Urachal masses observed in adults should be considered malignant unless they are confuted. It is very difficult to differentiate between malignant or benign lesions, including especially calcified foci and solid areas. CASE REPORT: Our case was a 63-year-old male patient who was diagnosed as Behçet's Disease 26 years ago. Upon clinical examination, he was also diagnosed with adenocarcinoma of prostate. He was examined by computerized tomography to define the stage of prostatic adenocarcinoma. The existence of a hypodense multiseptated cystic lesion with irregular margins and solid areas located between anterosuperior of bladder and umbilicus was reported. Hence, the lesion was evaluated as urachal carcinoma and locally advanced prostate cancer by the urooncology council. Resection of the mass, partial cystectomy and pelvic lymphadenectomy were performed as one of the surgical approach options in urachal carcinoma. After pathological examination, the mass was diagnosed as malakoplakia and metastasis of prostate adenocarcinoma was also detected in the right obdurator lymph nodule. In the literature, case reports of urachal malakoplakia are extremely rare. It is also interesting to note the absence of specific clinical symptoms for the urachal mass and the existence of concomitant adenocarcinoma in our case. CONCLUSION: Malakoplakia can only be diagnosed by pathological examination. Particularly, urachal malakoplakia should also be taken into consideration in the differential diagnosis of lesions which include solid areas and are located in the urachus.

Renal Infections.

This review discusses the various gross and histologic findings seen in renal infections due to bacteria, viruses, fungi, and mycobacteria. It is crucially important to separate infectious processes in the kidney from other inflammatory or neoplastic processes, as this will have a major impact on therapy. We describe the diagnostic features of renal infections with a specific focus on the differential diagnosis and other processes that may mimic infection. The topics discussed include acute bacterial pyelonephritis, chronic bacterial pyelonephritis, xanthogranulomatous pyelonephritis, malacoplakia, viral infections in the kidney, fungal pyelonephritis and mycobacterial infection of the kidney.

Malacoplakia of the epididymis.

Malacoplakia is a chronic inflammatory disease. The disease mainly affects the urinary bladder, although involvement of extravesical sites is increasingly being documented. Most frequently involved is the urinary tract, particularly the urinary bladder, although the testis, epididymis, lungs, bone, colon, prostate, female genital organs, and retroperitoneum can also be involved. Here we report the case of a 61-year-old man with a scrotal mass with histology that was specific for malacoplakia of the epididymis. The histologic workup demonstrated extensive involvement of the epididymis by diffuse infiltrates of large histiocytes with eosinophilic granular cytoplasm and numerous Michaelis-Gutmann bodies, which were diagnostic of malakoplakia. This is the first case of epididymal malacoplakia in our country and the first case of epididymal malacoplakia without concurrent involvement of the testis. There have been few reports of this condition worldwide.

Malacoplaquia renal. Presentación de caso / Renal Malakoplakia. Case report

Introducción: La malacoplaquia es una enfermedad granulomatosa multisistémica crónica caracterizada por una o múltiples placas blancas en varios órganos del cuerpo, precedida por alguna infección crónica bacteriana. En la mayoría de los casos estudiados se encuentra que la E. Coli contribuye en aproximadamente el 80 % de ellos. Objetivo: Dar a conocer la existencia de esta enfermedad y sus características mediante una revisión de tema, y exponer un caso de malacoplaquia renal en una mujer de 65 años de edad con múltiples comorbilidades asociadas a dicha entidad; se describe la utilización de los métodos diagnósticos, así como su desenlace. Discusión: La malacoplaquia es una patología que se encuentra frecuentemente en el tejido urinario, a pesar de que puede desarrollarse en otros órganos. Su etiopatología no ha sido totalmente explicada; sin embargo, se asume que se da por un defecto en la actividad fagolisosomal, al parecer por alteración en la concentración de guanosín monofosfato cíclico intracelular (cGMP) en macrófagos y monocitos. Los pacientes que cursan con esta patología pueden ser asintomáticos o presentar síntomas inespecíficos. Conclusión: La malacoplaquia es una entidad que, aunque poco frecuente en la población general, debe tenerse en cuenta cuando existe compromiso uni o multifocal del parénquima renal en pacientes con factores de riesgo. Las imágenes pueden no ser concluyentes y hacer sospechar patología tumoral; sin embargo, el estudio histopatológico de la muestra permite un diagnóstico definitivo, lo cual les da la oportunidad a los pacientes de recibir manejo oportuno con excelentes resultados.

Introduction: Malakoplakia is a chronic multisystemic granulomatous disease characterized by the presence of one or multiple white plaques in various organs of the body, preceded by some chronic bacterial infection. In most reported cases it is found that E. coli contributes in approximately 80% of cases. Objective: The objective of this article is to show a case report of this disease and its characteristics through a review of the subject. We present a case of renal Malakoplakia in a 65-year-old woman with multiple comorbidities associated with this entity. We emphasize on the use of the diagnostic methods, as well as the outcome. Discussion: Malakoplakia is a pathology that is usually found in the urinary tissue, although it may develop in other organs. Its cause has not been fully explained and it is assumed to be due to a defect in phagolysosome activity, apparently by alteration in the concentration of intracellular cyclic guanosine monophosphate (Cgmp) in macrophages and monocytes. Patients with this pathology may be asymptomatic or have non-specific symptoms. Conclusion: Malakoplakia is an entity that although rare in the general population should be taken into account when there is uni or multifocal involvement of the renal parenchyma in patients with the potential risk where the role of imaging is to provide a first work-up of the extension, with the final work-up taking place through histopathological studies, giving patients the opportunity to receive timely treatment with excellent results.

Renal malacoplakia: Case report of a differential diagnosis for renal cell carcinoma.

BACKGROUND: Renal malacoplakia is a very rare chronic inflammatory disorder characterized by specific infiltration of tissue by inflammatory cells, and presents similar radiological characteristics to those of renal cell carcinoma. CASE REPORT: A 54-year old woman, with a 37-year history of smoking, weight loss, anorexia, asthenia, and night sweats, was included in an antiangiogenesis clinical trial. Clinical signs of inflammation were apparent in the right lumbar region without functional limitations. Previous imagery identified a mass infiltrating the lower pole of the right kidney, extending to the psoas, perinephretic region and ganglia. Biological testing revealed inflammation and a urinary tract infection, treated with ciprofloxacin. Based on histology of a renal puncture biopsy, clear cell carcinoma with oxyphilic cells was suspected but not confirmed by immunohistochemistry. Urine analysis was positive for Escherichia Coli. Computed tomodensitometry revealed three masses (right kidney, between right psoas and the inferior vena cava, and right psoas) and a second puncture biopsy confirmed malacoplakia. After successful antibiotherapy, a right-sided nephrectomy was performed. The patient now shows no evidence of disease. CONCLUSIONS: This case underscores the importance of excluding the differential diagnosis of renal malacoplakia before undertaking partial or total nephrectomy and/or initiating neoadjuvant treatment for renal cell carcinoma.

Cutaneous malakoplakia: case report and review / Malacoplaquia cutânea: relato de caso com revisão da literatura

Malakoplakia is a rare acquired disease that can affect many systems but is more common in the urogenital tract. Cutaneous malakoplakia is even rarer. It is far more frequent in immunodeficient patients. We report a case of cutaneous malakoplakia in a kidney transplant patient who had recently stopped receiving immunosuppressive therapy to illustrate a review of the relevant recent literature.

Malacoplaquia é uma doença adquirida rara que pode afetar diversos órgãos e sistemas, mas é mais comum no trato urogenital. O acometimento cutâneo é ainda menos frequente. Atinge principalmente imunodeficientes. Relatamos caso de malacoplaquia cutânea em um paciente transplantado renal que havia recentemente deixado de receber a terapia imunossupressora, a fim de ilustrar uma revisão da literatura recente relevante.

Malacoplaquia diseminada: evoluciónexcepcional de una rara patología / Disseminated malakoplakia: exceptional development of an inusual pathology

La malacoplaquia es una enfermedad granulomatosa crónica que afecta principalmente el tracto genitourinario, si bien puede asentar en cualquier órgano de la economía, habitualmente autolimitada y benigna. Las formas extravesicales presentan un curso másagresivo. El diagnóstico es histopatológico, siendo patognomónicos los cuerpos de Michaelis-Guttmann. Se vincula a infecciones crónicas, enfermedades sistémicas, inmunodepresión y neoplasias. El tratamiento médico es inespecífico y en caso de masas voluminosas se plantea conducta quirúrgica. El pronóstico está íntimamente relacionado a la localización del proceso y a la presencia de enfermedades concomitantes.El caso de malacoplaquia reportado es excepcional por la presentación clínica (HDA reiteradas), por el origen topográfico, el compromiso ganglionar y la diseminación de la afección, así como por el curso evolutivo maligno de la misma.

Malakoplakia is a chronic disease which primarily affects the Genitourinary tract, although it can appear in any body,usually self-limited and benign. Extravesical forms evidencea more aggressive course. Diagnostic is done through histopatology, being Michaelis-Guttmann bodiespathognomonic. It is associated to chronic conditions, systemic diseases, immune depression and neoplasia. Medical treatment is non-specific and in the case of voluminous masses surgery is recommended. Prognosis is closelyrelated to the localization of the process and the present of concomitant diseases.The malakoplakia case reported is unusual given its clinical presentation (repeated high digestive hemorrhage),the topographical origin, lymph node commitment and the dissemination of the condition, as well as its malignevolution.

A malacoplaquia é uma doença granulomatosa crônica que afeta principalmente o trato geniturinário embora possa se desenvolver em outros órgãos; geralmente é autolimitada e benigna. As formas extravesicais são mais agressivas. O diagnósticoé histopatológico, sendo patognomônicos os corpos de Michaelis-Guttmann. Está vinculada a infecções crônicas, doenças sistêmicas, imunodepressão e neoplasmas.O tratamento médico é inespecífico e quando se observam massas voluminosas se indica cirurgia. O prognóstico está estreitamente relacionado à localização do processo e a presença de doenças concomitantes.O caso de malacoplaquia que se descreve apresenta características excepcionais pelo quadro clínico (HDA repetidas), por sua origem topográfica, o compromisso ganglionar e a disseminação, como também pela evolução maligna.