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Malacoplakia often is considered a benign disease. Our recent experience with renal parenchymal malacoplakia and a review of the literature have revealed the clinical and pathologic features as well as the prognosis of this renal disease. Upper urinary tract malacoplakia is neither benign nor self-limited, and bilateral renal parenchymal involvement has been uniformly fatal.

The authors report 5 new cases of malakoplakia: 2 with kidney, 1 with prostatic and 2 with testicular involvement. The symptoms are not clinically specific, but pseudo-tumor forms are predominant. Four cases were treated by removal of the organ. Owing to a better understanding of its etiopathogenic mechanism, this disease can be treated by long-term antibiotic, cholinergic agonists and vitamin C therapy.

We report a case of urethral malacoplakia associated with disease of the bladder and bladder neck. Treatment consisted of fulguration of the bladder lesions and excision of the urethral lesion. Unlike most other cases of genitourinary malacoplakia, which are associated with chronic urinary tract infection, this patient had sterile urine and no history of urinary tract infections. Urethral malacoplakia is reviewed, and the pathogenesis and treatment of the disease are discussed.

The authors report about the observation of a case of malacoplakia with rectal involvement. They lay stress on the usefulness of computed tomography and of rectal echography, which allow assessing extension within the rectal wall and, as the case may be, into the lymph nodes. These examinations also allowed following up the disease, the signs of which abated with antibiotic treatment.

The computed tomography and ultrasound findings of two patients with malacoplakia of the bladder, both at the time of initial diagnosis and following response to treatment, are presented. Because bladder wall involvement is demonstrated by these modalities in female patients with repeated episodes of urinary tract infection, this entity should be entertained in the differential diagnosis.

Two cases of histiocytic endometritis are described, both characterized by total replacement of the endometrium with sheets of lipid-containing histiocytic cells. This condition appears to be a rare complication of cervical occlusion and it is suggested that the histiocytic reaction occurs as a response to a haematometra.

Genitourinary malacoplakia in renal transplant patients is rare. We report a case of malacoplakia of the bladder, which presented as a vesical tumor.

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.

The authors present a study of 38 cases of renal malacoplakia, two of which are personal. The clinical roentgenological and pathological data of such a histologically defined disease are reviewed. Nosological and physiopathological recollection is necessary before discussing management.

Conjunctival and tonsillar sites for malakoplakia have never been previously described. The diagnosis in these presented cases has only been arrived at after elimination of mycosis and parasitic disease. The aetiology remains unknown and the pathophysiology is discussed.

We report the twentieth case in the world literature of testicular malacoplakia. This lesion occurs mainly in middle-aged men, appearing clinically as epididymo-orchitis or enlargement of the testicle with fibrous consistency and some soft areas. Malacoplakia is now considered a nonspecific inflammatory granulomatous lesion subsequent to an infection by gram-negative bacteria. In our case Escherichia coli was cultured in the urine and testicular tissue. The ultrastructural study shows the histiocytic nature of the cellular infiltrate as well as the morphology of Michaelis-Gutmann bodies. Bacilliform structures were not found. The cellular and humoral immunological studies did not show alterations.

Brief clinical characteristics and microscopic structure of a peculiar focal granulomatosis, macrophagal affection of the urinary bladder mucous membrane, are described. Microscopically, malacoplakia of the urinary bladder has a zonal structure the presence of which is important for differential diagnosis from some tumours, particularly myoma consisting of myoblasts and malignant histiocytoma. The presence of small rounded basophilic inclusions (Mikhaelis--Gutmann bodies) is a characteristic feature of malacoplakia.

Clinically, malacoplakia of the prostate gland may mimic prostatic carcinoma. We report a case of prostatic malacoplakia in which transrectal ultrasound of the prostate was most compatible with carcinoma. However, fine needle aspiration cytology and biopsy revealed the classical histopathological features of malacoplakia so that a correct diagnosis could be made.

A case of retroperitoneal malakoplakia is reported. A 50-year-old female was admitted with the chief complaint of right flank pain. Intravenous pyelography, computed tomography, selective iliac arteriography and abdominal echography revealed right pararenal abscess and the right renal tumor suspected. About one liter of yellowish fluid was drained from the retroperitoneal space, but no right renal tumor was found. Pathological diagnosis was retroperitoneal malakoplakia postoperatively. This is assumed to be the second case of retroperitoneal malakoplakia in Japan.

2 further cases of malakoplakia of the prostate are reported, so that a total of 23 cases have now been described. The histological picture, as well as the methods of staining for the demonstration of the pathognomonic Michealis-Gutmann bodies are reviewed. The presence of Escherichia coli as a possible factor in the etiology is discussed. A description is given of the symptoms and physical findings in cases of prostatic malakoplakia, and the differential diagnosis, with particular reference to cancer of the prostate, is reviewed. Histology alone can provide the correct diagnosis. Finally it is emphasized that malakoplakia can be treated with long-term antibiotic therapy.