Malakoplakia of the colon associated with villous adenoma: report of a case

Malakoplakia Associated With Multiple Adenomas of the Colon: An Extremely Rare Incidental Finding

Malakoplakia in the colon has been described either as part of a systemic disease with a diffuse presentation or as a rare incidental finding associated usually with an adenocarcinoma. To our knowledge, the association of malakoplakia with colonic adenoma is very rare and only 5 cases, including the present case, have been reported so far. Here, we describe a case of malakoplakia coexisting with multiple sigmoid colonic adenomas in a 67-year-old patient without any underlying inflammatory or infectious disease and with no history of immunosuppressive treatment. As far as we are concerned, this is the first description of malakoplakia associated with multiple colonic adenomas.

Malakoplakia and colonic adenoma: a rare association

We report the case of a 73-year-old woman who presented respectively a caecal adenocarcinoma, two high-grade dysplastic tubulo-villous adenomas of the right colon, and a well differentiated adenocarcinoma developed on a high-grade dysplastic tubulo-villous adenoma of the left colon. One of the right colonic adenomas was ulcerated and showed typical foci of malakoplakia in the lamina propria. Malakoplakia is a histiocytic inflammatory response that may be associated with inflammatory and infectious diseases, immunosuppressive therapy, or colorectal carcinoma. Association of malakoplakia with colonic adenoma is rare; only three cases have been described in the literature thus far. To verify if this association is more common than usually suspected, we reviewed 100 colonic adenomas measuring at least 2 cm. No other case of malakoplakia associated with adenoma was found. The patient did not suffer from any other inflammatory or infectious disease and she was not under any medication or immunosuppressive therapy. Our observation confirms the isolated association of malakoplakia and colonic adenomas and the rarity of this association.

Malakoplakia in association with colorectal carcinoma: a series of four cases

AIMS

Malakoplakia is a characteristic inflammatory condition which is usually seen in the urogenital tract. Gastrointestinal malakoplakia is seen in association with a variety of conditions such as ulcerative colitis, diverticular disease, adenomatous polyps and carcinoma. The purpose of this paper is to report four additional cases of colorectal cancer associated with malakoplakia and review the literature on this association.

METHODS

All specimens were colectomies for cancer. Routine handling of the specimen with lymph node harvesting was performed. In addition to H&E stains, PAS, Perls' Prussian Blue and von Kossa stains were performed.

RESULTS

Three of the cases were encountered in males and the patients ranged in age from 55 to 64 years. One case each occurred in the caecum/ascending colon and descending colon, while the remaining two were located in the rectum. All four cases were Dukes' stage B tumours. Furthermore, all four cases had spread to pericolic fat and two had perforated. Microscopic examination showed the malakoplakia to be present at the infiltrating edge of the tumours. The draining lymph nodes were involved by malakoplakia to varying degrees in all cases.

CONCLUSIONS

From this series and the literature review, malakoplakia associated with colorectal cancer tends to occur in elderly males in the rectum. The malakoplakia is found at the infiltrating front of the tumour and is not admixed with the neoplastic glands. Although lymph node involvement by malakoplakia has been reported only once previously, all four cases in this series showed evidence of involvement. The association does not appear to have any prognostic significance.

Malacoplakia simulating organ invasion in a rectosigmoid adenocarcinoma: report of a case

Malacoplakia is a histiocytic inflammatory response that may be associated with colorectal tumors. We report the case of a 65-year-old male taking steroids for a severe pulmonary disease. He presented with a rectosigmoid tumor that seemed to infiltrate the urinary bladder and the sacrum on the preoperative CT scan and echography and at laparotomy. A low anterior resection en bloc with a partial cystectomy was performed. The pathologic analysis showed a pT3pN0 adenocarcinoma with an extensive malacoplakia infiltrating the bladder and the pericolic and perirectal tissues. This case report emphasizes the overstaging that malacoplakia may induce and underlines a situation the surgeon may possibly confront. Our observation confirms the association of malacoplakia, colorectal carcinoma, and steroid treatment.

Clear cell change in colorectal adenomas: its incidence and histological characteristics

AIMS

The aim of our investigation was to clarify the histological characteristics and biological significance of clear cell change in colorectal adenomas. METHODS ANID RESULTS: We found three cases (0.086%) of tubular adenomas with clear cell change in a review of 3486 cases of colorectal adenoma. These three cases occurred in male patients and were located in the left-sided colon. To investigate the nature and biological significance of the clear cells, we conducted histochemical staining (periodic acid-Schiff (PAS) with or without diastase digestion, alcian blue pH 2.5) and immunohistochemical staining (using antibodies against carcinoembryonic antigen (CEA), alpha-fetoprotein, p53 protein and Ki67 antigen) and also mitotic counts. Histologically, the changed area was characterized by pyknotic and randomly arranged nuclei with PAS-negative clear and vacuolated cytoplasm. Immunoreactivity for CEA was diffuse and strong in the clear cells, but not in the tumour cells in the ordinary portion of the adenomas. The Ki67 labelling index and the mitotic activity were both higher in the clear cell portion than in the ordinary portion.

CONCLUSIONS

This is the first study to indicate the incidence of clear cell change among colorectal adenomas. It has confirmed high proliferative activity within the clear cell portion of colorectal adenomas.

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.

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 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.