Malacoplakia of the ovary, fallopian tube and uterus: a case associated with diabetes mellitus

Ovarian tumour-cutaneous fistula as a primary presentation of pelvic malakoplakia coexisting with a benign ovarian tumour mimicking advanced ovarian cancer

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.

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.

Malakoplakia mimicking malignant ovarian tumor: A case report and literature review

INTRODUCTION AND IMPORTANCE

Malakoplakia is a rare inflammatory condition that generally occurs in immunocompromised individuals and is thought to be secondary to a bactericidal defect in macrophages.

CASE PRESENTATION

In this report, we present the case of a 50-year-old multiparous patient who presented with chronic pelvic pain. Ultrasonography revealed a suspicious left lateral-uterine mass. Laparoscopic exploration showed an inflammatory mass in the left adnexa adherent to the uterus, peritoneum, and meso-sigmoid. The patient underwent a total hysterectomy with bilateral salpingo-oophorectomy and peritoneal biopsy. Histological findings were consistent with a left adnexal location of malacopakia, and Bacteriological analysis revealed Escherichia coli infection sensitive to ciprofloxacin. At the 6-month follow-up, no recurrence was observed. The patient's condition improved following surgery and antibiotic treatment.

CLINICAL DISCUSSION

Genitourinary malakoplakia is more common in women and has no specific clinical, biological, or radiological features. Diagnosis is based on histological criteria, notably the presence of Michaelis-Gutmann bodies. Advances in our understanding of the pathophysiology of malakoplakia have made it possible to consider medical treatment options, mainly through the use of antibiotics. However, in cases where the organ is severely affected, surgical excision is recommended.

CONCLUSIONS

To summarize, adnexal malacoplakia is a highly uncommon disease that may be mistaken as a malignant tumor. The diagnosis is established through histological examination. The usual treatment is a combination of surgical excision followed by targeted antibiotic therapy, as the diagnosis is often not made until after surgery.

Xanthogranulomatous Endometritis with calculus formation in setting of prolapsed uterus

Xanthogranulomatous inflammation is a rare benign inflammatory lesion characterized by sheets of lipid-laden foamy histiocytes. It has been reported in various organs, mainly the kidney and gall bladder. Xanthogranulomatous endometritis (XGE) is sporadic, with only a few cases reported in the English medical literature. Herein, we report a case of xanthogranulomatous endometritis with the formation of stones in a 50-year-old female patient with a prolapsed uterus. Grossly the endometrium was irregular, and the uterine cavity was filled with a yellow friable material, a polypoid growth, and yellowish stones. The microscopy showed sheets of histiocytes with few preserved endometrial glands. In this case, the xanthogranulomatous inflammation may mimic a clear cell carcinoma involving the endometrium and myometrium. One of the important differential diagnoses is malakoplakia. Immunohistochemistry and special stains are helpful in diagnosis.

Malakoplakia of Endometrium with Osseous Metaplasia on Evaluation of Postmenopausal Leukorrhea: A Rare Case Report

Malakoplakia is a chronic xanthogranulomatous condition that affects the genitourinary tract reported earlier as urinary granulomas and pelvic masses. We report a different clinical manifestation of malakoplakia presenting as postmenopausal pyometra. A 64-year-old postmenopausal female presented with foul-smelling vaginal discharge with a past history of induced abortion, followed by dilatation and evacuation. On examination, abdomen was soft, vaginal examination revealed pus discharge, parous size uterus with free fornices, and pap smear ruled out malignancy. Ultrasonography revealed linear, echogenic structures in the endometrial cavity suspicious of bony spicules with fluid around. Hysteroscopy revealed congested endometrium with multiple pieces of shredded bone-like structures that were removed followed by curettage. Histopathological examination was suggestive of malakoplakia with osseous metaplasia. Retained bony spicules can cause chronic granulomatous inflammation that may become symptomatic postmenopause due to absent cyclical shedding. This is the first reported case of malakoplakia of uterus following retained bony spicules.

Xanthogranulomatous endometritis: A case report and literature review

Xanthogranulomatous endometritis is a rare benign pathology mimicking endometrial carcinoma.

Gastrointestinal Malakoplakia: Clinicopathologic Analysis of 26 Cases

Malakoplakia is an inflammatory process related to defective macrophage response to bacterial infection. To further characterize the clinicopathologic manifestations of gastrointestinal malakoplakia, 26 cases were identified from 6 institutions. Hematoxylin and eosin-stained slides and available stains were reviewed, and pertinent clinicopathologic features analyzed. Sixteen patients were women (62%). Mean patient age was 64 (range: 24 to 83). Sites included the colorectum (n=23), appendix (n=1), and stomach (n=2). Clinical indications for tissue procurement included screening (n=14), tumor resection (n=5), diarrhea (n=1), adenoma surveillance (n=1), ulcerative colitis flare (n=1), abdominal pain (n=1), and appendicitis (1). All cases featured histiocytes with abundant, pale, eosinophilic cytoplasm focally containing Michaelis-Gutmann bodies. The process frequently involved the mucosa (n=19), with architectural distortion in 13 cases. Lymphoid aggregates were present in 18 cases, which were prominent or obscuring in 11 (all colon biopsies) and provoked concern for lymphoma in 2. Associated findings included adenocarcinoma (n=5), adenoma (n=2), gastric hyperplastic polyps (n=1), chemical gastritis (n=1), collagenous colitis (n=1), and active chronic colitis (n=2). In cases with available stains, Michaelis-Gutman bodies were highlighted by Periodic Acid-Schiff with diastase, Von Kossa, and iron stains. Although 2 cases were positive for Tropheryma whipplei antibody, no T. whipplei transcripts were detected on real-time polymerase chain reaction. All patients with available follow-up are alive and well with no additional instances of malakoplakia. Malakoplakia of the gastrointestinal tract is a benign, incidental finding. Although histologic features in the stomach and colon resections are similar to those at other sites, exuberant lymphocytic response in colon biopsies and immunoreactivity with T. whippleii antibody may provoke initial confusion and lead to unnecessary time and resource investment.

Pelvic malakoplakia presenting as endometrial cancer: a case report

Malakoplakia is a rare granulomatous, inflammatory disease generally manifesting as ulcers of the urogenital tract, especially in the bladder, but it can occur in any part of the body. Because of its varied clinical presentations, malakoplakia is considered for differential diagnosis upon suspicion. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies. We report a case of pelvic malakoplakia accompanied by left lower quadrant pain that was misdiagnosed as endometrial cancer with pelvic mass based on imaging studies. The patient underwent dilatation and curettage, and the pathology report revealed no malignancy. Because of persistent pain and septic shock, she underwent a debulking operation to remove the mass. Histopathologic examination revealed malakoplakia. For postoperative management, she received broad-spectrum antibiotics, but abdominal pelvic computerized tomography performed on postoperative day 9 revealed pelvic mass recurrence. To the best of our knowledge, this is the only rare case report of pelvic malakoplakia mimicking endometrial cancer.

Bilateral Ovarian Malakoplakia: Case Report and Review of the Literature With Clinical and Diagnostic Considerations

Malakoplakia is a rare condition in which histiocytic cells accumulate within different organs and tissues, sometimes mimicking neoplasia. Gynecologic involvement is extremely rare and therefore may cause relevant diagnostic confusion for both clinicians and pathologists. In this paper, we described the seventh case of ovarian malakoplakia, and we reviewed the literature to compare it with the previously reported ones. Moreover, we investigated the histologic and molecular differential diagnosis of malakoplakia, with special attention to other histiocytic disorders of gynecologic interest. Finally, we discussed the most relevant points with regard to possible pathogenesis and management. Malakoplakia often represents a forgotten entity that should be remembered preoperatively, when approaching a possible gynecologic neoplasia. Moreover, it is of remarkable importance to differentiate malakoplakia from multisystem histiocytosis involving gynecologic organs. All this would prevent misdiagnosis and overtreatment of such a rare but benign condition.

Xanthogranulomatous Endometritis: A Benign Uncommon Masquerader of Malignancy

Xanthogranulomatous endometritis is an uncommon benign lesion characterized by the destruction of endometrium and replacement by the sheets of foamy histiocytes, lymphocytes, plasma cells, multinucleated giant cells, fibrosis, calcification, and accompanying polymorphonuclear leukocytes. It is commonly mistaken for malignancy clinicoradiologically, and therefore, histopathological examination is of utmost importance. We report the case of a 61-year-old postmenopausal female who presented with pyometra, bulky uterus, and cervical stenosis, and histopathology revealed XGE.

Neck xanthogranuloma mimicking malignancy in a patient with diabetes mellitus: A case report and literature review

RATIONALE

Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues.

PATIENT CONCERNS

A 49-year-old diabetic patient presented with a right painful neck mass for a week. The pretreatment computed tomography (CT) imaging with contrast demonstrated a huge ill-defined heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. Both fine needle aspiration (FNA) and ultrasound-guided core biopsy of the neck mass showed inflammatory cells only.

DIAGNOSES

Histologic evaluation found granulation tissue with histiocytes and occasional Touton giant cells confirming the diagnosis of xanthogranuloma.

INTERVENTIONS

Open excisional biopsy demonstrated a yellowish mass-like lesion with abscess inside.

OUTCOMES

The patient recovered from the disease without posttreatment comorbidities.

LESSONS

This case highlights the need for physicians to maintain awareness of this clinical entity and delayed- or overtreatment should be avoided in these patients due to preoperative ambiguous diagnosis.

A novel cause of postmenopausal bleeding in an immunosuppressed patient

Malakoplakia is a rare histiocytic disease first described in 1902 by Michaelis and Gutmann. It is associated with host immunocompromise including chronic inflammatory conditions, infectious conditions or malnutrition. Here, we report the case of uterine malakoplakia as a rare cause of postmenopausal bleeding in an immunocompromised patient.

[Ovarian and tubal localization of a malakoplakia: report of a case and review of literature]

La malakoplakie est une pathologie inflammatoire rare qui résulte d'un déficit de la fonction phagocytaire macrophagique. Il n'existe pas de symptomatologie spécifique de la maladie mais dépendante de l'organe touché. Nous rapportons un cas rare de malakoplakie annexielle chez une femme de 36 ans qui a été opérée pour suspicion de cancer ovarien et dont le diagnostic de malakoplakie ne s'est fait qu’à l'examen anatomopathologique. La malakoplakie touche essentiellement le tractus urogénital et le diagnostic positif repose seulement sur l'histologie. Le traitement est basé sur l'antibiothérapie et l'exérèse chirurgicale si mauvais état de l'organe atteint.

Coexistence of renal malakoplakia and myelodysplastic syndrome

Malakoplakia is a protean systemic chronic granulomatous disease that usually targets the genito-urinary system and most particularly the bladder. Only in rare occasions do the kidneys get involved. Myelodysplastic syndrome is a heterogeneous clonal haematopoietic disorder characterised by either a hyper- or hypocellular bone marrow dysmyelopoiesis and peripheral blood pancytopenia. The synchronous association of these two unrelated disorders has never been reported. We report a 62-year-old woman who initially developed vague, relapsing gastrointestinal symptoms synchronous with renal malakoplakia and myelodysplastic syndrome.

Lethal outcome in xanthogranulomatous endometritis

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, while primary xanthogranulomatous endometritis (XE) is a very unusual finding, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We present the case of a 69-year-old woman with a short history of abdominal pain and a palpable mass in the pouch of Douglas. Dilatation of the cervix drained a pyometra. Histological examination of the curettage rendered the diagnosis of XE. Microbiological studies revealed enterococcus spp. and Peptostreptococcus magnus. Despite antibiotic treatment the patient died of heart failure due to systemic inflammation. Autopsy confirmed the diagnosis of XE with transmural extension into the peritoneal cavity. Such a lethal course of XE is extraordinary. Proposed causes of XE include obstruction, infection and hemorrhage. Demonstration of enterococcus spp. and P. magnus supports the probable significance of bacteria in the development of XE. Because this condition may mimic malignant disease macroscopically and histologically, knowledge of XE is of major importance for both pathologists and gynecologists.

Endometrial coccidiosis

This report describes a case of granulomatous endometritis caused by coccidiosis in an immunologically uncompromised 63 year old patient. The glandular epithelium of the endometrium contained numerous intracytoplasmic cysts, corresponding to periodic acid Schiff positive and methenamine silver negative sporoblasts. The endometrial glands revealed reactive phenomena, such as eosinophilic and squamous glandular metaplasia and intraluminal desquamation. Non-necrotising epithelioid granulomata, lacking the presence of parasites, were present in the stroma. Although not detected in the stool examination, the organisms were probably Isospora belli. There was no evidence of other foci of the disease. Coccidiosis should be differentiated from the more commonly occurring coccidiomycosis.