Malakoplakia of the large intestine found incidentally at necropsy: light and electron microscopic features

Endoscopic mucosal resection of a rectal malakoplakia in a healthy adult

Malakoplakia in the gastrointestinal tract is rare in healthy young people without underlying disease. Sufficient tissue is required for accurate diagnosis. We describe a malakoplakia that developed in a healthy young woman and was treated by endoscopic mucosal resection (EMR). A 40-year-old woman with a history of taking oral contraceptives until one year earlier was referred to our hospital with anal bleeding and constipation. A colonoscopy carried out at our another hospital 18 months earlier disclosed no abnormal findings. Colonoscopy at presentation revealed a yellowish-white tumor, 5 mm in diameter, in the rectum. The lesion was slightly protruded and had a smooth flat surface, without erosion or ulceration. EMR was carried out for a definitive diagnosis. Histopathological examination showed that the tumor contained granular histiocytes, positive for CD68 and negative forcytokeratin (AE1/AE3). Several histiocytes contained intracytoplasmic round bodies (Michaelis-Gutmann bodies), which reacted positively with periodic acid-Schiff and calcium (Von Kossa) stains. Intracytoplasmic Escherichia coli (von Hansemann bodies) were identified by Giemsa staining. Based on these results, the tumor in the rectum was diagnosed as a malakoplakia. Following EMR, the patient did not receive further treatment for malakoplakia because she had no symptoms associated with malakoplakia. She has been well for more than 9 months, with no symptoms of disease. Awareness of colorectal malakoplakia is important in patients taking steroids, including oral contraceptives.

Rectal and cutaneous malakoplakia in an orthotopic cardiac transplant recipient

Malakoplakia, from the Greek term meaning "soft plaque," is a rare granulomatous disease first documented by Michaelis and Gutmann in 1902, and is most commonly found in association with systemic diseases such as systemic lupus erythematosus, tuberculosis, diabetes mellitus, sarcoidosis or neoplasm. We present a case report of malakoplakia in a 55-year-old female patient who had undergone an orthotopic cardiac transplant for ischemic cardiomyopathy. She was found to have an irregular rectal mass, after presenting with a complaint of hematochezia and pressure with defecation as well as a "boil" on her right labia. Malakoplakia is an exceedingly rare disease entity, and this is only the third known report of this condition in a patient after cardiac transplantation. We review the current perspectives on the pathophysiology, diagnosis and treatment of this disease.

Colonic malacoplakia: unusual association with ulcerative colitis

A 44 year old Chinese female with malacoplakia of the colon associated with ulcerative colitis was presented. The patient showed typical histological, electron microscopic and X-ray micro-analysis findings of malacoplakia. The malacoplakia gradually disappeared after discontinuation of high-dose systemic steroid prescribed by private practitioner for the ulcerative colitis. A review of the 26 previously reported cases of malacoplakia of the colon is also included. Coupled with the clinical events of this patient, it appears that malacoplakia is likely to be secondary to immunosuppression, due to drugs, malignant or debilitating diseases.

Urinary tract malakoplakia with extension into the retroperitoneum with secondary gastrointestinal involvement

A rare case of malakoplakia of the urinary tract with diffuse retroperitoneal extension is presented. Sonographically guided cytologic puncture revealed the pathologic diagnosis. The splenic flexure of the colon and the stomach appeared to be secondarily involved in the inflammatory retroperitoneal tumor. The relative role of the various imaging modalities in defining retroperitoneal extension of the disease is illustrated, with a special reference to computed tomography and endosonography. After antimicrobial treatment and left nephrectomy, partial regression of the retroperitoneal mass was documented.

Colonic malacoplakia and abdominal tuberculosis in a child. Report of a case with review of the literature

A 4 1/2-year-old girl had colonic malacoplakia of two years' duration, the presenting symptom being rectal bleeding. Abdominal tuberculosis and Escherichia coli lumbar abscess were diagnosed at the age of 3 1/2 years. Despite antituberculous treatment, there was no improvement and she died from protein-losing enteropathy. The patient is discussed and the literature reviewed, with special emphasis on the incidence of malacoplakia in children, the aggressive nature of colonic malacoplakia, and the lack of response to treatment. A brief review of the pathogenesis of malacoplakia is considered.

Malakoplakia of the maxillary sinus

The first case of malakoplakia in the nasal cavities is reported. The patient, a 21-year-old man, presented a polypoid formation in the left maxillary sinus that was removed and studied by light and electron microscopy. The polypoid formation consisted of pseudostratified epithelium surrounding a central myxoid tissue which contained fibroblasts, histiocytes, and small inflammatory infiltrates. The most relevant features were histiocyte accumulations containing 1 to 5-microns diameter granules which displayed a concentric multilayered configuration. Ultrastructural findings revealed three types of lysosomes within the histiocyte cytoplasm: phagolysosomes, intermediate bodies, and Michaelis-Gutmann bodies. Septate junctions between lysosomes were frequent. The etiopathogenesis of this lesion is discussed.

Colonic malacoplakia

Malacoplakia is an uncommon, pathologically distinct, granulomatous disease most frequently found in the urinary tract. Malacoplakia of the colon may cause abdominal pain, diarrhea, rectal bleeding, and fever. Radiographic features are variable and include polyps, bulky masses, mucosal ulcerations, and fistulae.

Malacoplakia of the gallbladder

A case of malacoplakia of the gallbladder is described. The cytoplasm of histiocytes in the gallbladder wall was filled with granules positive for periodic acid-Schiff, von Kossa's, and Perls' stains, which is highly suggestive of malacoplakia. Both local inflammation and recent neoplasia could have played a role in the histogenesis of the malacoplakia.

Malakoplakia of the colon and recurrent colonic strictures in a patient with primary hypogammaglobulinemia: an association not previously described

A nine-year old boy with primary hypogammaglobulinemia and recurrent colonic strictures who developed malakoplakia of the colon is reported on. Such an association has not been reported previously. The development of colonic strictures is not considered a gastrointestinal manifestation of hypogammaglobulinemia. Malakoplakia of the colon is a rare disease, with 26 cases being reported to date. Only five children under age 13 have been reported with colonic malakoplakia and none with hypogammaglobulinemia. Hypogammaglobulinemia should be added to the growing list of conditions predisposing to the development of malakoplakia.

Malakoplakia of the adrenal gland

The clinical and pathological features of a case of malakoplakia of the adrenal gland occurring in a woman with Escherichia coli infection are described. This lesion mimicked a neoplasm, the true diagnosis only being revealed by histological examination. The light and electron microscopic features are described and it is suggested that malakoplakia is due to an abnormal macrophage response to E coli infection.

The ultrastructural features of malakoplakia

The ultrastructural features of a case of disseminated malakoplakia are described and compared with available published cases. Generally macrophages were involved (although characteristic inclusions were seen in association with some plasma cells) and contained three types of cellular inclusions. These were (1) the phagolysosomes (2) and intermediate structure sharing features of the phagolysosome and the Michaelis-Gutmann (MG) body and (3) the MG body. All inclusions were delineated by unit membranes and their matrices (except those of large MG bodies) composed of membranous whorls and loops. It is suggested that these inclusions represent stages in the development of the MG body. Septate junctional complexes were observed between phagolysosomes and small MG bodies. These complexes may represent either a mechanism of organelle fusion or an abnormality of molecular organisation of the limiting unit membrane.

Malakoplakia of the gastrointestinal tract

The clinical and pathological features of 3 cases of colonic malakoplakia are documented thereby bringing to 34 the total of recorded cases of malakoplakia involving the gastrointestinal tract. This is therefore the most common site of involvement outside the urogenital tract. A comprehensive review of the world literature on gastrointestinal malakoplakia has been made and the characteristic features of the condition have been delineated. There was a bimodal age incidence with a small cluster of cases occurring in childhood and associated with significant additional systemic disease. In the adult cases the average age was 57 years with a slight excess of males. The most commonly involved part of the gastrointestinal tract was the colon and colonic carcinoma was the most common associated disease.

An unusual case of supraclavicular and colonic malakoplakia--a light and ultrastructural study

A case of malakoplakia of the supraclavicular region and colon in a 41-year-old patient is presented. Clinical, histopathological, histochemical and ultrastructural features are described. The etiology and pathogenesis are discussed. Malakoplakia is a chronic inflammatory disorder probably due to an abnormal response to infection with Gram negative bacteria, most likely Escherichia coli or Klebsiella. The disease is characterised by the accumulation of macrophages intermixed with plasma cells and lymphocytes. The malakoplakic cells are laden with phagolysosomes which may provide a suitable biochemical environment for the deposition of calcium to form the pathognomonic Michaelis-Gutmann bodies. Ultrastructural examination enhances the accuracy of diagnosis since it highlights the presence of lysosomes, phagolysosomes, Michaelis-Gutmann bodies, and intact E. coli or their remnants.