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Infectious pseudotumors are unusual proliferations of histiocytes in response to certain microbial organisms. Occasionally this process may involve large airways, producing a mass lesion that may cause respiratory obstruction. Infectious pseudotumors can be confused with malignancy in their radiologic appearance and clinical presentation. We present a case of an aggressive endotracheal pseudotumor associated with Rhodococcus equi infection in a patient with advanced HIV disease. Microscopically, the lesion was composed of sheets of epithelioid histiocytes with large, strongly eosinophilic intra-cytoplasmic granules and features of malakoplakia. In this report, we review the literature of these unusual lesions and compare them to cases of conventional malakoplakia involving the large airways. We also explore the pathogenetic mechanisms that may contribute to the distinctive histologic appearance of Rhodococcus-associated pseudotumors.

Malakoplakia is a rare chronic inflammatory condition characterized by defective macrophage function, most of which involve the genitourinary tract, and renal parenchymal involvement is uncommon. We present a case of malakoplakia affecting renal parenchyma. A 46-year-old woman with pyrexia and jaundice was referred to our department. Abdominal enhanced CT scan revealed a left pyelonephritis with ureteral stone and bilateral renal abscesses. Despite the insertion of a left ureteral stent and administration of antibiotics, the patient showed persistent high fever and elevated CRP, and no obvious improvement in clinical and imaging data. In view of the limited effectiveness of the conservative treatment in this case, we decided to perform left nephrectomy. The diagnosis of malakoplakia was made based on the histopathological findings of von Hansemann cells and Michaelis-Guttmann bodies detected in the nephrectomy specimen. She is clinically healthy up to the present (50 months after surgery) with normal clinical indicators and CT findings.

Idiopathic granulomatous orchitis is a rare inflammatory process of the testis of unknown etiology. It is characterized by presence of non-specific granulomatous inflammation and admixed multinucleated giant cells. It usually presents as a testicular mass which is highly suspicious of malignancy. Histologically, there is extensive destruction of seminiferous tubules with tubular or interstitial pattern of granulomatous inflammation and prominent collagen fibrosis. Trauma and possible auto-antibodies against sperms have been postulated to be the underlying mechanism. Differential diagnoses include intratubular germ-cell neoplasia, malignant lymphomas, and malakoplakia. Orchiectomy is currently the most appropriate therapy for this condition., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

A 66 years old man visited our hospital with a chief complaint of right flank pain and abdominal palpable mass. Abdominal enhanced computed tomography scan showed a large cystic mass with infiltrating surrounding tissue in the right kidney. We diagnosed it infected cystic renal cell carcinoma because of high grade fever and acute inflammatory response. It was surgically unresectable tumor. Therefore, percutaneous puncture and drainage was performed under ultrasound guidance. In the culture of drainage fluid, Escherichia coli (E. coli) was isolated. Then, we confirmed reduction in the size of the tumor, right radical nephrectomy was performed. Because of tumor invasion to ascending colon, we performed the excision of right kidney together with ascending colon. Histological study confirmed target-shaped Michaelis-Gutmann body, and the definitive diagnosis was malacoplakia of the kidney. We reported a case of renal malacoplakia that was difficult to distinguish from cystic renal cell carcinoma. Our case is 12th case of renal malacoplakia in the Japanese literature.

Malakoplakia is an inflammation which is thought to develop secondary to chronic Escherichia coli infections. Although often seen in the genitourinary tract, it can also be seen in colon, stomach, lung, liver, bone, uterus, and skin. In this case report, we present prostatic malakoplakia diagnosed by elevated prostate-specific antigen level and transrectal prostate biopsy., (Copyright © 2011 Elsevier Taiwan LLC. All rights reserved.)

Malacoplakia is an unusual chronic granulomatous inflammation that commonly occurs in the urinary tract. It is rarely encountered in the head and neck region, and only a handful of such cases have been described. We report a case of malacoplakia in a 50-year-old woman who presented with a mass in the vallecula that was clinically suspected of being malignant. This case illustrates the importance of recognizing this unusual benign lesion, which closely mimics a malignancy on clinical examination.

Malakoplakia of lung is an unusual condition that has been reported to occur in association with immunocompromised state, particularly in those with acquired immunodeficiency syndrome. We present two cases of pulmonary malakoplakia in immunocompetent individuals. The diagnosis was made on histopathological examination of surgically resected specimen.

A 67-year-old Saudi man with poorly controlled diabetes-mellitus underwent orchiectomy for a painful left testicular swelling that did not respond to antibiotics. Clinical diagnosis was testicular malignancy. Histologic workup demonstrated extensive involvement of the testis and epididymis by diffuse infiltrate of large histiocytes with eosinophilic granular cytoplasm and numerous Michaelis-Gutmann bodies, which were diagnostic of malakoplakia. Very rarely, malakoplakia has been described in association with diabetes mellitus. Such an extensive malakoplakia occurring at an unusual site in association with systemic illness lends support to the view that a compromised immune status could be etiologically important in malakoplakia. We present this case to highlight the importance of diagnosing malakoplakia when it occurs at unusual locations. We also explore the role of diabetes mellitus in the pathogenesis of malakoplakia and compare the relationship between malakoplakia and xanthogranulomatous inflammation, which are closely related to each-other on both clinical and morphologic grounds.

Background: Malakoplakia is a very rare chronic inflammatory disorder, first described in 1902. In 75% of cases, the condition affects the genitourinary tract. Five cases of malakoplakia affecting the neck were previously reported in the literature., Methods and Results: An 83-year-old woman presented with an enlarging mass in the posterior triangle of the neck that was histologically confirmed as malakoplakia. Presenting features are often nonspecific, and the diagnosis is dependent on histological findings. The characteristic microscopic findings are of Michaelis-Gutmann (M-G) bodies that stain positive with periodic acid-Schiff reagent, von Kossa's reaction for calcium, and Perl's ferrocyanide reaction to ferric iron., Conclusion: Although rare, a diagnosis of malakoplakia should be considered in patients with an enlarging mass. This may mimic the presentation of malignancy, particularly in patients in whom erosion through skin occurs, and histological confirmation is advocated.

Gastrointestinal system is the second most common site for the occurrence of malakoplakia. We report two cases of pediatric colonic malakoplakia with the endoscopic and characteristic histologic findings. Malakoplakia is rare in pediatric age group, no clinical and endoscopic findings are diagnostic and the condition can masquerade as other conditions like inflammatory bowel disease and tumors.

Unlabelled: Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is hardly known, but it thought to be secondary to an acquired bactericidal defect in macrophages occurring mostly in immunosuppressed patients., Case Report: 63-year-old female patient had been treated with methylprednisolone for ten years, because of pulmonary sarcoidosis. For six month, recurrent abdominal abscess and vesico-cutaneous fistula developed. Histological examination proved malakoplakia, and Escherichia coli was detected in the abscess cavity., Methods: Hematoxyline eosin staining, periodic acid-Schiff, Berlin-blue and Kossa reactions were performed., Results: Microscopically malakoplakia consists of mainly macrophages, known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. In our presented case, after urological-surgical intervention and antibiotic therapy, the patient became free from complaints and symptoms., Discussion: Malakoplakia has been described in numerous anatomic locations, mainly in the urogenital tract. Malakoplakia may be complicated with fistulas in different locations: vesico-coccygeal, rectoprostatic, anorectal fistulas have been were reported in the literature, while 6 cases of malakoplakia with Boeck's sarcoidosis are published., Conclusion: In the presented case sarcoidosis and the 10-year immunosuppressive treatment with methylprednisolone might have been in the background of abdominal wall malakoplakia, complicated by vesico-cutaneous fistula. The patient was successfully treated with surgery and the followed antibiotic therapy.

Malakoplakia is an uncommon inflammatory condition usually affecting the genitourinary tract, which has been associated with infections, tumors, and immunocompromised states. The condition has been reported in many different organs and it may rarely involve the skin. We describe a case of an isolated perianal cutaneous malakoplakia in an immunocompetent 23-year-old Syrian male.

Malakoplakia that presents in the head and neck is rare. We describe a case in a man who presented with a fungating mass in the periauricular skin that was thought to be a malignant tumour. Histopathological and microbiological investigations established a diagnosis of malakoplakia., (Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Malakoplakia is a uncommon chronic granulomatous condition of a benign nature preferentially occurring in the genitourinary tract. Testes are affected in 12% of cases, and the first case of testicular malakoplakia was reported in 1958. Forty cases have been reported worldwide since that date. We report a new case of testicular and epididymal malakoplakia in a 68-year-old male patient diagnosed of complicated orchiepididymitis who underwent orchidectomy to rule out a malignant tumor. The histopathological study demonstrated a chronic inflammatory infiltrate with histiocytes with an eosinophilic cytoplasm containing the characteristic Michaelis-Gutmann bodies diagnostic of malakoplakia. In connection with this new case and because of its unusual presentation, the literature on testicular malakoplakia is reviewed., (Copyright 2008 AEU. Published by Elsevier España, S.L. All rights reserved.)

Background: A 48-year-old woman with chronic urinary tract infections presented with uremia. Imaging studies revealed bilateral hydronephrosis and segmental ureteral thickening., Investigations: Physical examination, urine and blood analysis, radiography of the chest, chest CT, abdominal and pelvis CT, renal ultrasonography, cystoscopy, anterograde pyelogram, bladder biopsy., Diagnosis: Malacoplakia involving bilatateral ureters and bladder; cavitary pneumonia., Management: Hemodialysis, placement of bilateral percutaneous nephrostomy tubes, administration of ciprofloxacin, ascorbic acid and bethanechol.

Malakoplakia is a rare, chronic inflammatory condition characterized by defective macrophage function. The majority of cases involve the genitourinary tract, but isolated cases have been reported from other organ systems including one prior report involving the maxillary sinus. We present a case of malakoplakia expanding the frontal and ethmoid sinuses mimicking a mucocele at presentation. The diagnosis was made at the time of surgery based on the histopathologic finding of von Hasemann cells and Michaelis-Guttmann bodies. Sinus-specific clinical aspects will be discussed including diagnostic and treatment considerations. Laryngoscope, 2009.

Malakoplakia represents a chronic inflammatory disease associated with a broad spectrum of bacterial infections. On histopathology, Michaelis-Gutmann bodies are considered as pathognomonic histopathological findings. Rarity of the disease and wide variety of clinical presentation makes its diagnosis very challenging. We report herein the case of a 66-year-old woman who, having undergone lower anterior resection for rectal adenocarcinoma 3 and a half years ago, presented with urinary frequency and dull abdominal pain. CT scan revealed a soft tissue tumour infiltrating the preperitoneal fat over the urinary bladder, which was considered as recurrence of the rectal carcinoma. On laparotomy, a tumour invading the bladder, small intestine and the anterior abdominal wall was resected and the patient recovered uneventfully. On histopathology, malakoplakia of urinary bladder was revealed. Overstaging of patients' malignancy due to malakoplakia is not uncommon, so its early identification can help avoid incorrect treatment.

Malakoplakia is a rare chronic inflammatory disease that was originally described in the urinary bladder but can involve many other organs and soft tissues. It is believed to be caused by an alteration in the bacterial phagocytic system. Clinically, it is described as single or multiple tumors that can appear in any part of the body. Histologically, the presence of Michaelis-Gutmann bodies is pathognomonic. Malakoplakia in children is rare. Few pediatric cases in the urinary tract, kidney, or gastrointestinal tract have been published. We present a case of urinary and gastrointestinal malakoplakia in a 12-year-old girl.

Malakoplakia is a form of chronic granulomatous inflammation that in humans most commonly affects the urinary bladder of middle-aged women. Naturally occurring malakoplakia is rare in animals, having been described twice in the pig only. An 8-week-old kitten was diagnosed with malakoplakia of the urinary bladder after a 3-week history of dysuria. Post-mortem examination revealed a markedly enlarged bladder with a diffusely nodular mucosal surface. Microscopically, there was diffuse submucosal infiltration by histiocytes stained positively by periodic acid Schiff (PAS) and described in the human condition as "von Hansemann cells". Intracellular and extracellular "Michaelis-Gutman" inclusion bodies were seen on light and electron microscopical examination. These structures are considered pathognomonic for malakoplakia. The pathogenesis of malakoplakia is enigmatic. Defective function of phagolysosomes is currently suspected to underlie the abnormal accumulation of submucosal histiocytes; however the primary functional defect remains unknown.

We describe concomitant granuloma inguinale (GI) and malacoplakia of the cervix in 2 acquired immune deficiency syndrome (AIDS) patients aged 27 and 36 years. Both patients presented with a bloody foul-smelling vaginal discharge. Speculum examination confirmed cervical ulceration, prompting the diagnosis of cervical carcinoma in both patients. Cervical punch biopsies confirmed the characteristic features of GI; granulation tissue containing a dense plasma cell infiltrate, aggregates of neutrophils, and vacuolated enlarged histiocytes containing Donovan bodies were noted. Many of these histiocytes and sheets of von Hansemann cells contained intracytoplasmic Michaelis-Gutmann bodies, confirming concomitant malacoplakia. Michaelis-Gutmann bodies were also present in extracellular locations. Ultrastructural examination confirmed these histopathologic findings. One patient died of disseminated tuberculosis before treatment was initiated. The other patient did not return for a follow-up visit of her cervical lesion. Concomitant GI and malacoplakia is unreported in genital and extragenital sites; Klebsiella granulomatis must therefore be added to the list of bacteria associated with malacoplakia. Malacoplakia of the female genital tract is documented rarely and remains unreported, to date, in AIDS patients. Similar to the pathogenetic mechanisms described for AIDS-associated malacoplakia in extragenital sites, it is hypothesized that, in addition to abnormal macrophage functioning and an inability to degrade bacteria, special constituents of K. granulomatis are undigestable by lysosomal enzymes in human immunodeficiency virus-infected patients.

We report about a rare case of malakoplakia in a female urethral diverticulum. A 25-year-old patient with a long history of recurrent urinary tract infections and a plum-sized, painful swelling on the vaginal roof presented for operative treatment. In the anamnesis the patient reported about two spontaneous perforations, emptying several millilitres of pus each time. After total operative excision using a vaginal approach the histology showed malakoplakia in a urethral diverticulum. We found the typical intracytoplasmatic "Michaelis-Gutmann bodies" as well as "von Hansemann cells". Postoperatively we excluded an underlying tumour disease or a chronic infection. The further urological diagnostics (cystoscopy and MRI) were without any pathological findings. In patients with atypical cystic tumours of the urogenital tract, especially with an immune deficiency, malakoplakia should be taken in consideration. The preferred therapy is surgical management followed by long-term antibiosis as well as a close follow-up as recurrences are frequent.

Malakoplakia, typically involving the urinary tract, is an uncommon form of chronic inflammation caused by chronic infections and characterized by accumulation of macrophages. It has also been found in many other sites such as the gastrointestinal tract, pancreas, liver, lymph nodes, skin, respiratory tract, adrenal gland, vagina and brain. We present a case of a 64-year-old man referred to our hospital with cachexia and radiologic evidence of metastatic tumor of the liver. Colonoscopy revealed a large malignant - appearing polypoid mass of the ascending colon and multiple distinct polyps throughout the rest of the colon. Biopsies of the ascending colon mass confirmed the diagnosis of adenocarcinoma. Histological examination of two of the other polyps revealed malakoplakia which was characterized by aggregates of granular histiocytes with Michaelis - Gutmann bodies and histochemically confirmed with periodic acid-Schiff and von Kossa stains. This is a rare case diagnosed on endoscopic samples. The majority of reported cases were found in surgical specimens. In addition, the endoscopic appearance of multiple polyps is unusual in malakoplakia.

Malacoplakia is a relatively rare form of chronic granulomatous inflammation. Which occurs most frequently in the genito-urinary system, but renal parenchymal involvement is rare. We present a case of malacoplakia of the renal parenchyma. A 69-year-old woman with left renal mass was referred to our department. Abdominal enhanced CT scan revealed heterogeneous mass in the left kidney (50 x 45 mm). CT-guided percutaneous left renal needle biopsy confirmed the diagnosis of renal malakoplakia. We successfully treated her with oral levofloxacin. The lesion resolved after the 4-months-therapy, and there has been no recurrence for 22 months since the treatment.

Malakoplakia is a rare inflammatory condition seen in transplant patients. There are two previously reported cases of malakoplakia involving the gastrointestinal tract in liver transplant patients. The present paper reports a case of colonic malakoplakia in a 58-year-old woman, a liver transplant recipient who was receiving immunosuppressive drugs. She presented with chronic diarrhea while on tacrolimus. There was no history of antecedent infection. Colonoscopy showed patchy mucosal edema, but no discrete yellow plaques or nodules. The diagnosis was made by colon biopsies, which showed chronic inflammation with many histiocytes containing Michaelis-Gutmann bodies. Although rare, malakoplakia is one of many potential causes of diarrhea in a transplant patient. The present case indicates that malakoplakia may be associated with chronic diarrhea, even if there are no macroscopic lesions seen during colonoscopy.

Malakoplakia of the urinary tract is a granulomatous inflammatory disease due to bacterial infection and can usually be treated conservatively, whereas all of the past reported patients with solitary ureteral malakoplakia underwent surgical excision. We report a patient with solitary isolated upper ureteral malakoplakia that was successfully diagnosed by ureteroscopic biopsy. After conservative treatment with levofloxacin, bethanechol chloride and ascorbic acid, her right hydronephrosis and the lesion were reduced for more than six months.

Malacoplakia is a rare inflammatory condition characterized by demonstrative Michaelis-Gutmann bodies, which are foamy histiocytes with distinctive basophilic inclusions. Malacoplakia is caused by the inadequate elimination of bacteria by macrophages or monocytes as a result of defective phagocytic activity. Xanthogranulomatous pyelonephritis is characterized by the destruction of renal parenchyma and its replacement by solid sheets of foamy lipid-laden macrophages. Prolonged infection of the kidney, which is frequently caused by an obstruction of the urinary tract, is the pathologic mechanism of that condition. We present a 6-year-old patient with a poorly functioning kidney who had a prolonged recurrent urinary tract infection. The results of histologic analysis revealed an inflammatory infiltration consisting predominantly of foamy and epithelioid histiocytes that contained round intracytoplasmic concretions characteristic of Michaelis-Gutmann bodies. We suggest that malacoplakia might be a stage of xanthogranulomatous pyelonephritis.

Malakoplakia, from the Greek term meaning "soft plaque," is a rare granulomatous disease first documented by Michaelis and Gutmann in 1902, and is most commonly found in association with systemic diseases such as systemic lupus erythematosus, tuberculosis, diabetes mellitus, sarcoidosis or neoplasm. We present a case report of malakoplakia in a 55-year-old female patient who had undergone an orthotopic cardiac transplant for ischemic cardiomyopathy. She was found to have an irregular rectal mass, after presenting with a complaint of hematochezia and pressure with defecation as well as a "boil" on her right labia. Malakoplakia is an exceedingly rare disease entity, and this is only the third known report of this condition in a patient after cardiac transplantation. We review the current perspectives on the pathophysiology, diagnosis and treatment of this disease.

We report the MRI appearances in a patient with parametrial malakoplakia. The patient complained of pelvic pain and vaginal discharge. Physical examination revealed a "frozen" pelvis suggestive of malignancy. MRI showed bilateral parametrial "infiltration", but no overt primary pelvic tumour. The combination of these findings together with the inflammatory symptoms suggested an inflammatory condition. Malakoplakia was confirmed at resective biopsy.

We report a case of a 76-year-old man with bilateral pulmonary and pleural nodules and type 2 diabetes mellitus. Laboratory investigations revealed no sign of immunodeficiency. Pleural, pulmonary and diaphragmatic biopsies were taken through a mini-thoracotomy. Pathology showed Michaelis-Gutmann inclusion bodies and diagnosis of malacoplakia was made. Malacoplakia masquerading as bilateral tumour masses was thought to be noteworthy especially in an immunocompetent patient.

Malakoplakia (MLP) is a rare chronic granulomatous disease that is believed to happen because of an alteration in the bacterial phagocytic system. This entity is characterized by one or multiple tumorations that can appear in any part of the body leading to it's misdiagnosing as a malignant condition. The genitourinary tract is frequently involved. Pathologic study of these lesions shows tissue infiltrated by inflammatory cells (macrophages and hystiocites) with intracytoplasmatic inclusions, which are known as Michaelis-Gutmann bodies. Usually is a benign condition self-limited and is associated with recurrent urinary tract infection (UTI), this condition has a good response to prolonged treatment with fluoroquinolones. We will report six cases that were diagnosed and treatment in our institution during an eight year period. We report still a review of the available literature.

Malakoplakia is a rare pseudotumoral inflammatory disease known to affect immunocompromised subjects. We report a 4-year-old boy with malakoplakia of colon who was diagnosed with celiac disease in late infancy; despite aggressive nutritional and medical management for celiac disease, symptoms did not resolve. His nitro-blue-tetrazolium test was compatible with chronic granulomatous disease. In colonic biopsy Michaelis-Gutmann bodies were seen.

The authors describe a 44-year old woman's case where a tumor of her lower abdomen has been clinically found. CT of the abdomen showed involving the abdominal wall and urinary bladder. Histologically has been found the specific von Hansemann cells and Michaelis-Gutmann bodies warranting a diagnosis of malakoplakia Partial resection of urinary bladder and mm recti abdominis has been performed. The patient is clinically healthy until present (36 months) with normal laboratory indicators and CT find. The clinical symptoms of this very rare disease are different and depend upon the organ location. The soft tissue tumor-like lesions can mimic a variety of malignant, inflammatory, and infectious diseases. The accurate histologycal estimate leads to mild surgical intervention and postoperative comfort for the patient.

Malakoplakia is a rare inflammatory disease, related to Enterobacteria infection in the context of a disorder of cell-mediated immunity. This disease does not have any specific clinical or laboratory signs and the diagnosis is exclusively based on histology. Malakoplakia is exceptional in children and usually involves the gastrointestinal tract. The authors report a rare case of malakoplakia of the urinary bladder in a 4-year-old child, in whom the initial diagnosis was an anomaly of the urachus.