Cases reported "Malacoplakia"

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1/13. Detection of the 20-kDa virulence-associated antigen of rhodococcus equi in malakoplakia-like lesion in pleural tissue obtained from an AIDS patient.

    A malakoplakia-like lesion was detected in a pleural biopsy from an AIDS patient presenting clinical and radiologic features of pneumonia. Cultures of bronchoalveolar lavage and pleural fluid evidenced rhodococcus equi as the causative agent of pleuro-pulmonary infection. Immunochemical characterization of the R. equi isolate showed the presence of a strain similar to the ATCC 33704 reference strain presenting the capsular antigen of serotype 4, and the intermediate virulence-associated antigen of 20-kDa. Histopathology of the patient's pleural biopsy showed plaques of macrophages interspersed with lymphocytes, and intracytoplasmic cocci and bacilli in macrophages, which were variably acid-fast positive. immunohistochemistry of cocci, bacilli and their degradation products resulted strongly positive when stained with a mouse monoclonal antibody (MAb) produced against the 20-kDa antigen. This finding could have important implications for the pathogenicity of R. equi for human beings, since we do not know yet all the factors involved in the formation of malakoplakia. Indeed, the results obtained in the present study, taken together with the results obtained for pigs inoculated with R. equi strains of intermediate virulence (Madarame et al. 1998), raise the possibility that most strains presenting the 20-kDa antigen may be capable of inducing malakoplakia. If this hypothesis is confirmed by immunohistochemical analysis of human pulmonary malakoplakia cases due to R. equi, the detection of this antigen may be extremely helpful in the diagnosis and treatment of such patients. This is the first report of R. equi infection in human beings that suggests a relationship between pleural malakoplakia and the virulence-associated antigen of 20-kDa.
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2/13. Isolated gastric malakoplakia: a case report and review of the literature.

    A 62-year-old African American woman presented with weight loss and dyspepsia. She did not have any clinical evidence of immunodeficiency. Upper gastrointestinal endoscopy revealed multiple small polypoid lesions in the gastric body and fundus that appeared larger and more erythematous than usual fundic gland polyps. Examination of biopsy specimens revealed an infiltrate of large histiocytes with eosinophilic granular cytoplasm located in the lamina propria and containing Michaelis-Gutmann bodies. These histologic findings were diagnostic of gastric malakoplakia. Gastrointestinal malakoplakia is uncommon, and exclusive gastric involvement is extremely rare. Because occult bacterial infection has been postulated as the underlying cause of malakoplakia, the presence of helicobacter pylori infection was investigated using immunohistochemical and serologic techniques, and the presence of yersinia enterocolitica or yersinia pseudotuberculosis infection was investigated by polymerase chain reaction assay. There was no evidence of H pylori, Y enterocolitica, or Y pseudotuberculosis in these biopsy specimens, and there was no evidence of malakoplakia or concurrent malignancy at any other site. Follow-up examination 12 months later revealed no endoscopic or histologic improvement.
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3/13. Malakoplakia of the skin. Ultrastructure and quantitative x-ray microanalysis of Michaelis-Gutmann bodies.

    The etiologic agent in a case of malakoplakia of the skin was identified as staphylococcus aureus from culture of the lesion and from ultrastructural observations. Ultrastructurally, electron-dense inclusions were observed in addition to membranous whorls and Michaelis-Gutmann (MG) bodies. These were labeled "precalcification formations" since they possessed an organic crystalline structure. These formations may act as nucleation centers for further incorporation of organic and inorganic material. Deposition of fine crystalline material in the outer region may occur as the structure becomes saturated with inorganic elements, thus completing formation of the MG body. Quantitative x-ray microanalysis of MG bodies demonstrated the presence of phosphorus, calcium, and iron, with average concentrations of 2.1%, 2.6%, and 0.7% by weight, respectively.
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4/13. Prostatic malacoplakia. An ultrastructural and immunohistochemical study.

    A case of malacoplakia of the prostatic gland associated with prostatic nodular hyperplasia from a 69 years old man was presented, and its light and electron microscopic and immunohistochemical features were discussed along with its pathogenesis. This lesion was incidentally found in a transurethral prostatectomy specimen, and consisted of large number of epithelioid cells in which were typical cytoplasmic inclusions known as Michaelis-Gutmann bodies. Ultrastructurally, these inclusions showed a dense, central calcified bodies of various developmental stages. Immunohistochemical study using antilysosomal antibody revealed no lysosomal activity. Based on these findings, we could suspect that main problem for this development of malacoplakia is altered intracellular digestion process of foreign biologic materials.
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5/13. Malakoplakia in ulcerative colitis.

    Classic malakoplakia was found in the colon of a patient with a 30-year history of proven ulcerative colitis. She had undergone total proctocolectomy after failure of medical treatment to control her illness. Immunoperoxidase studies showed immunoglobulins and muramidase within the malakoplakic histiocytes, and electron microscopy showed bacteria resembling escherichia coli in the same cells. Immunologic studies on the patient showed an unusually high E coli antibody titer (1:512) in her serum and reduced numbers of circulating t-lymphocytes with reduced cytotoxic activity. This case shows the paradoxical rarity of malakoplakia in ulcerative colitis and reaffirms the presence of an immunologic defect that may be pathogenetically significant.
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6/13. Cytologic diagnosis of extravesical malacoplakia.

    malacoplakia, a rare form of chronic granulomatous inflammation, most frequently involves the urinary tract of middle-aged women. The disease represents an unusual inflammatory response to bacteria, most commonly escherichia coli, and probably reflects some dysfunction in the immune system of the host. We describe two cases of malacoplakia involving in one patient the vagina and in the other the perianal subcutaneous tissue and lung. In both cases, the diagnosis was made concurrently by cytology and histologic examination of tissue sections. This, in turn, led to the institution of appropriate therapy with complete resolution of the disease. In smears, the characteristic von Hansemann histiocytes are larger than alveolar macrophages. They have a reticulated granular cytoplasm that is caused by excessive accumulation of lysosomal bodies, some of which upon mineralization give rise to the pathognomonic Michaelis-Gutmann body. The latter, which is usually intracellular, can be distinguished readily from psammoma bodies and should not be confused with yeasts.
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7/13. Malakoplakia of the stomach. Report of a case and review of the literature.

    A case of malakoplakia of the stomach associated with well-differentiated adenocarcinoma of the transverse colon was studied by light and electron microscopy. The gross appearance consisted of a slightly elevated plaque with umbilication of the covering mucosa. Histologically, the lesion was composed of submucosal proliferation of histiocytes with the typical cytoplasmic inclusions known as Michaelis-Gutmann bodies. Ultrastructurally, these inclusions had a dense central calcified body and concentric alternating rings. Twenty-four cases of gastrointestinal malakoplakia from the literature, including two cases of gastric malakoplakia, were reviewed.
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8/13. malacoplakia of the uterine cervix: report of two cases.

    Two cases of malacoplakia involving the uterine cervix are reported. Lesions of the genital tract caused by this uncommon granulomatous reaction may suggest malignancy clinically and may present with vaginal bleeding. Cytologic findings in cervical smears from both patients included inflammation and abundant histiocytes. The characteristic finding is the Michaelis-Gutmann body, which can be identified in cervical smears, especially with the use of PAS or von Kossa stain. Gram-negative bacilli may be cultured from the tissue or identified on Gram's stain. Antibiotics are probably effective in eradication, as is surgical excision.
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9/13. Malakoplakia of the larynx.

    The first case of malakoplakia of the larynx in the world literature is reported. The soft raised plaques were removed from a 61-year-old white male, who was a heavy smoker and complained of hoarseness, but was otherwise in good general condition. From the follow-up of our patient, it is concluded that malakoplakia is not of particularly bad prognosis when affecting the larynx, and that simple local excision seems to be enough to produce cure. On these grounds, the laryngologists should be aware of the entity and consider it when dealing with raised nodules or plaques in the larynx, while the pathologists should be alert to look for the Michaelis-Gutman bodies, when encountered with peculiar histiocytic reactions anywhere in the body, even in the larynx.
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10/13. Renal parenchymal malakoplakia--a case report and review of the literature.

    Malakoplakia is an inflammatory condition associated with persisting bacterial antigen in macrophages and characterized histologically by the Michaelis-Gutmann body, containing bacterial fragments. We review the pathogenesis of malakoplakia and report a novel form of treatment successfully used in an 8-week-old infant with bilateral renal malakoplakia. The patient presented with an acute escherichia coli urinary tract infection and enlarged kidneys. Antibiotic regimes were ineffective, but once the diagnosis was made treatment was changed to an immunosuppressive regime of prednisolone and azathioprine, to which she responded promptly. Renal malakoplakia should be considered in any patient with a urinary tract infection unresponsive to antibiotics and enlarged kidneys. Although a large proportion of patients with malakoplakia have an underlying systemic disorder, which may account for their abnormal macrophage function, the rest demonstrate either an isolated macrophage defect or no detectable anomaly at all. It is in this latter group we suggest that an immunomodulating regime can be curative.
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