Pelvic malakoplakia simulating recurrence of rectal adenocarcinoma: report of a case

Cecal malakoplakia: A case report

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.

Malakoplakia of the Urogenital Tract

Malakoplakia is a rare, granulomatous condition most commonly found in the genitourinary tract. It can present in a myriad of ways depending on the organ involved, thus presenting a huge diagnostic challenge. We present 4 patients with genitourinary malakoplakia, who manifested with recurrent urinary tract infection (UTI) and hematuria in all except one, who presented with hydronephrosis secondary to a large pelvic mass. We discuss the need for a high index of suspicion and careful scrutiny of histology to order to avoid misdiagnosis as simple long term antibiotics are an effective treatment in all but those with large pelvic masses.

Malakoplakia of the esophagus caused by human papillomavirus infection

Malakoplakia is a rare granulomatous disease probably caused by infection and characterized histologically by Michaelis-Gutmann bodies. We report a more rarely seen case esophageal malakoplakia in a 54-year-old woman. She presented with coughing while eating and drinking. Gastroscopy showed yellow nodules in the esophagus, and endoscopic ultrasonography showed a space-occupying lesion in the substratum of the esophageal mucosa. All findings highly resembled esophageal cancer. Histopathological examination finally indentified this space-occupying lesion as malakoplakia and not cancer. Immunohistochemistry showed that she had human papillomavirus (HPV) infection in the esophagus, which indicates that infection was responsible for the malakoplakia. This is believed to be the first case of malakoplakia in the esophagus, and more importantly, we established that HPV infection was the initiator of esophageal malakoplakia.