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Haq K, Ghaly M, Pelland KT, Dogbey P. Malakoplakia presenting with urinary tract infection, acute kidney injury, and bilateral renal enlargement in an immunocompetent patient. J Nephrol 2023; 36:2641-2643. [PMID: 37924475 DOI: 10.1007/s40620-023-01796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/26/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Kanza Haq
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Medhat Ghaly
- Yale University School of Medicine, New Haven, CT, USA.
- Department of Medicine, Waterbury Hospital, Waterbury, CT, USA.
| | - Kevin T Pelland
- Department of Pathology, Waterbury Hospital, Waterbury, CT, USA
| | - Pia Dogbey
- Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine, Waterbury Hospital, Waterbury, CT, USA
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2
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Șerban C, Toma A, Voicu DC, Popazu C, Firescu D, Țocu G, Mihailov R, Rebegea L. A Surgical Challenge Generated by Colonic Malakoplakia in Disguise as a Locally Advanced Colonic Malignancy-A Case Report. Medicina (B Aires) 2023; 59. [PMID: 36676780 DOI: 10.3390/medicina59010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Colonic malakoplakia is an uncommon granulomatous development of cells resulting from the impaired capacity of the mononuclear cells to eliminate the phagocytosed bacteria, and in rare cases it can also affect the gastrointestinal tract. We report the case of a 78-year-old female patient that was admitted to hospital by The Emergency Department with the diagnosis of bowel obstruction, confirmed by the clinical and paraclinical investigations. We decided to surgically manage the case for suspicious symptomatic colonic neoplasm. The histological examination of the surgical specimens revealed colonic malakoplakia, characterized by the presence of the aggregated granular histiocytes and Michaelis-Gutmann bodies. Through this paper, we want to raise awareness for Malakoplakia, which remains an extremely rare disease that may affect multiple organs, and because it does not present specific symptoms or clinical manifestations, the final diagnosis remains the histopathological study. The clinical conduct should be decided after taking into consideration all the aspects of this pathology along with the benefits and risks for the patient.
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Taher M, Shahsia R, Ebrahimi Daryani N. Malakoplakia as a Rare Cause of Diarrhea: Case Presentation and Review of Literature. Middle East J Dig Dis 2021; 13:71-74. [PMID: 34712442 PMCID: PMC8531935 DOI: 10.34172/mejdd.2021.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
Colonic malakoplakia is a rare chronic granulomatous disease that can involve many organs such as the lung, brain, pancreas, bone, adrenal glands, and genitourinary tract. The most common site of involvement outside the genitourinary tract is the gastrointestinal tract. We report a case of colonic malakoplakia who presented with unintentional weight loss, abdominal pain, and chronic diarrhea. There was a history of lupus nephritis and Sjogren disease, receiving various immunosuppressive drugs. Physical examination other than pallor was unremarkable in this patient, but colonoscopy revealed multiple polyps in the rectum with a cobblestone appearance in the cecum. The histopathological assessment showed infiltration of numerous lymphoplasma cells and neutrophils in the lamina propria, and rare Michaelis-Gutmann bodies were seen in foamy epithelioid histiocytes. These findings are suggestive of malakoplakia. We treated the patient with tetracycline, and after 3 months of follow-up, clinical improvement was achieved.
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Affiliation(s)
- Mohammad Taher
- Assistant Professor of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shahsia
- Associate Professor of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser Ebrahimi Daryani
- Professor of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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4
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Abstract
Malakoplakia in humans most often affects the urinary bladder and is characterized by inflammation with von Hansemann-type macrophages, with or without Michaelis-Gutmann bodies, and is frequently associated with Escherichia coli infection. We describe the microscopic features of malakoplakia in the urinary bladder of 4 puppies. In all cases, the lamina propria of the urinary bladder was markedly expanded by sheets of large, round to polygonal macrophages with intracytoplasmic, periodic acid-Schiff-positive granules and granular inclusions, and rare Prussian blue-positive inclusions. Macrophages were positive for CD18 and Iba1. In 2 cases, Michaelis-Gutmann bodies were detected with hematoxylin and eosin stain and were best demonstrated with von Kossa stain. E. coli infection was confirmed in 2 cases with bacterial culture or polymerase chain reaction (PCR) and sequencing of the bacterial 16S ribosomal RNA gene. Transmission electron microscopy of one case demonstrated macrophages with abundant lysosomes, phagolysosomes, and rod-shaped bacteria. Microscopic features were similar to human cases of malakoplakia. In dogs, the light microscopic characteristics of malakoplakia closely resemble granular cell tumors and histiocytic ulcerative colitis.
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Affiliation(s)
- Katelin L. Davis
- Purdue University, West Lafayette, IN, USA,National Cancer Institute, Bethesda, MD, USA
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5
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Cięszczyk K, Puderecki M, Wronecki L, Burdan F, Szumiło J. Malakoplakia of the urinary system. Folia Med Cracov 2019; 59:67-74. [PMID: 31659350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Malakoplakia is regarded as a chronic granulomatous inflammatory disease with a good prognosis. It usually affects the urinary system, especially the urinary bladder. Bacterial infections, including E. coli are thought to be the main factor in pathogenesis. It frequently coexists with chronic diseases and immunosuppression state. Histopathological examination of affected tissue samples is thought to be the best diagnostic method. The basic microscopic feature is mixed inflammatory infiltration containing foamy histiocytes known as von Hansemann cells, frequently with basophilic inclusions known as Michaelis-Gutmann bodies. Symptoms and the clinical course of malakoplakia depend on location and the extent of the lesions. The lesion is treated successfully with antibiotic therapy and surgical excision.
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Affiliation(s)
- Katarzyna Cięszczyk
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland.
| | - Michał Puderecki
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Lech Wronecki
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Franciszek Burdan
- Department of Human Anatomy, Medical University of Lublin, Lublin; Department of Radiology, St Johns' Cancer Center, Lublin, Poland
| | - Justyna Szumiło
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
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Velasquez MC, Taylor Smith PJ, Prakash NS, Kava B, Kryvenko ON, Castillo-Acosta R, Bittencourt LK, Gonzalgo ML, Ritch C, Parekh DJ, Punnen S. Malakoplakia of the prostate diagnosed on multiparametric-MRI ultrasound fusion guided biopsy: A case report and review of the literature. Urol Case Rep 2017; 18:94-96. [PMID: 29785385 PMCID: PMC5958940 DOI: 10.1016/j.eucr.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/17/2017] [Accepted: 11/17/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Maria C Velasquez
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paul J Taylor Smith
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Bruce Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosa Castillo-Acosta
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Smith-Pliego M, Contreras-Ruiz J, Ryan S, Sibbald RG, Hanna W, Roldan-Marin R. Cutaneous malakoplakia masquerading as pyoderma gangrenosum. Int Wound J 2016; 14:658-660. [PMID: 27524799 DOI: 10.1111/iwj.12661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022] Open
Abstract
Cutaneous malakoplakia is a rare infection-related granulomatous disease frequently associated with immunocompromised states. Foamy macrophages containing basophilic granules, called the Michaelis-Gutman bodies, are pathognomonic. We report a case of cutaneous malakoplakia in a 77-year-old male with pyoderma gangrenosum and a 2-year history of a non-healing malleolar ulcer treated successfully with cotrimoxazole.
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Affiliation(s)
- Mariam Smith-Pliego
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Jose Contreras-Ruiz
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Siobhan Ryan
- International Interdisciplinary Wound and Ostomy Care Center, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada
| | - R Gary Sibbald
- International Interdisciplinary Wound and Ostomy Care Center, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada
| | - Wedad Hanna
- Department of Pathology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada
| | - Rodrigo Roldan-Marin
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
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9
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Boubess I, Ouassour S, Tazi M, Filali A, Alami M. [Ovarian and tubal localization of a malakoplakia: report of a case and review of literature]. Pan Afr Med J 2015; 22:17. [PMID: 26600916 PMCID: PMC4646435 DOI: 10.11604/pamj.2015.22.17.6561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/20/2015] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Ikram Boubess
- Service de Gynécologie-Obstétrique Maternité des Orangers CHU Ibn Sina, Rabat, Maroc
| | - Salma Ouassour
- Service de Gynécologie-Obstétrique Maternité des Orangers CHU Ibn Sina, Rabat, Maroc
| | - Mokha Tazi
- Service de Gynécologie-Obstétrique Maternité des Orangers CHU Ibn Sina, Rabat, Maroc
| | - Adib Filali
- Service de Gynécologie-Obstétrique Maternité des Orangers CHU Ibn Sina, Rabat, Maroc
| | - Mohammad Alami
- Service de Gynécologie-Obstétrique Maternité des Orangers CHU Ibn Sina, Rabat, Maroc
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Sato H, Tsukamoto T, Mizuno Y, Ichikawa T, Kotani Y, Honda K, Hatta K, Kuroda M. Endoscopic mucosal resection of a rectal malakoplakia in a healthy adult. Dig Endosc 2014; 26:749-51. [PMID: 24373062 DOI: 10.1111/den.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/27/2013] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Harunobu Sato
- Department of Surgery, Rokuwa Hospital, Inazawa, Japan; Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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11
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Abstract
Malakoplakia is an unusual chronic inflammatory condition characterized by the presence of Michaelis-Gutmann bodies. Patients with malakoplakia often have an immunodeficiency state. It is believed that malakoplakia results from a defective macrophage response to phagocytosed bacteria. Malakoplakia most commonly affects the genitourinary tract. Cases confined to the liver are rare, with only five cases described in the literature. We report two cases of malakoplakia of liver; both were incidental autopsy findings. The first case involves a 53-year-old man with systemic lupus erythematosus and chronic refractory pancytopenia who presented with febrile neutropenia. His blood culture was positive for Stenotrophomonas maltophilia and Enterococcus faecium, and he subsequently developed invasive pulmonary aspergillosis. The second case involves a 60-year-old man who presented with a mass in periorbital tissue which, on biopsy, showed inflammation and Treponema-like spirochetes. He died unexpectedly at home. Autopsy revealed adrenal gland chronic inflammation and abscess. Both cases had grossly normal livers with microscopic findings of calcified targetoid structures consistent with Michaelis-Gutmann bodies. In these cases, malakoplakia was an incidental finding confined to liver. Although asymptomatic in these cases, diagnosis in the liver may be useful to initiate a search for hepatic or non-hepatic infections.
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Affiliation(s)
- Noha Botros
- Department of Pathology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia B3H 1V8, Canada.
| | - Sen R Yan
- Department of Pathology, Dr. Chalmers Regional Hospital, Fredericton, NB, Canada
| | - Ian R Wanless
- Department of Pathology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia B3H 1V8, Canada
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12
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Abstract
Malakoplakia is a rare, granulomatous, inflammatory disease that mimics malignant tumors and can affect any organ. Herein is described a case of malakoplakia in a 10-month-old slaughter pig. Diffuse, pleomorphic, round cell infiltrates, mainly histiocytes, with a tumor-like growth pattern at gross examination, infiltrated the stomach, pancreas, omentum, and mesenteric lymph nodes. The histiocytes and multinucleated giant cells had concentric, target-like inclusions known as Michaelis-Gutmann bodies. Microorganisms were not detected by the periodic acid-Schiff reaction, Ziehl-Neelsen, Gram, and Warthin-Starry staining or by electron microscopic and bacteriologic investigations. Porcine circovirus type 2 and porcine reproductive and respiratory syndrome viruses were not detected by immunohistochemistry in the sections examined.
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Affiliation(s)
- D Gelmetti
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - L Gibelli
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - L Gelmini
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy
| | - G Sironi
- Dipartimento di Scienze Veterinarie e Sanità Pubblica, School of Veterinary Medicine, University of Milan, Italy
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13
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Abstract
Malakoplakia is a rare granulomatous disease that occurs commonly in the urinary tract and secondarily in the gastrointestinal tract. Most reported cases of malakoplakia are associated with immunosuppressive diseases or chronic prolonged illness. Here, we report a rare case of malakoplakia in a young healthy adolescent without any underlying disease. A 19-year-old female was referred to our hospital following the discovery of multiple rectal polyps with sigmoidoscopy. She had no specific past medical history but complained of recurrent abdominal pain and diarrhea for 3 months. A colonoscopy revealed diverse mucosal lesions including plaques, polyps, nodules, and mass-like lesions. Histological examination revealed a sheet of histiocytes with pathognomonic Michaelis-Gutmann bodies. We treated the patient with ciprofloxacin, the cholinergic agonist bethanechol, and a multivitamin for 6 months. A follow-up colonoscopy revealed that her condition was resolved with this course of treatment.
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Affiliation(s)
- Kyung Hee Hyun
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Deok Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Dong Hoon Kim
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
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Yang YL, Xie YC, Li XL, Guo J, Sun T, Tang J. Malakoplakia of the esophagus caused by human papillomavirus infection. World J Gastroenterol 2012; 18:6690-2. [PMID: 23236248 PMCID: PMC3516212 DOI: 10.3748/wjg.v18.i45.6690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 02/06/2023] Open
Abstract
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.
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