Malakoplakia: A Pseudoneoplastic Disease of the Rectum

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.

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.