Cases reported "Malacoplakia"

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1/11. Xanthogranulomatous pyelonephritis and malacoplakia of the bladder in a middle aged female.

    We describe the case of a female with xanthogranulomatous pyelonephritis and malacoplakia of the bladder, presenting with recurrent urinary tract infection and renal mass. The genitourinary tract should be explored to evaluate the coexistence of these two diseases. nephrectomy and bladder mass resection is warranted to maintain sterile urine. This case represents an unusual instance of the synchronic appearance of xanthogranulomatous pyelonephritis and malacoplakia of the bladder, implying a common pathogenesis for two related diseases from a different histological spectrum, in which the urinary obstruction serves as a promoting factor for the stepwise transformation of morphogenesis.
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2/11. gallium scan in the diagnosis and treatment of renal malacoplakia.

    A middle-aged female was admitted with a presumptive diagnosis of pyelonephritis that failed to respond to conventional antibiotic therapy. Multiple investigations to define the etiology of the persistent fever and accompanying acute renal failure were negative. A gallium scan revealed intense uptake in the renal parenchyma. Percutaneous renal biopsy revealed malacoplakia. Six weeks of therapy with ciprofloxacin resulted in resolution of fever, improvement in the follow-up gallium scan, and reversal of the acute renal failure.
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3/11. Renal parenchymal malakoplakia. Histologic spectrum and its relationship to megalocytic interstitial nephritis and xanthogranulomatous pyelonephritis.

    We report five cases of renal parenchymal malakoplakia. They represent a histologic spectrum of this uncommon inflammatory process as it involves the renal parenchyma. Only one of these five cases presented the classical histologic picture of malakoplakia ("diagnostic stage"). Two cases--although with similar cellular infiltrate--had a marked paucity of Michaelis-Gutmann bodies and thus might have been classified as megalocytic interstitial nephritis were it not for the identification of such calcific intracellular inclusions under the electron microscope. The fourth case presented a pseudosarcomatous morphology and is similar to what has been described as a late or fibrous stage in malakoplakia of the urinary bladder. The last case had a destructive, frankly granulomatous histologic picture with a preponderance of foamy histiocytes reminiscent of xanthogranulomatous pyelonephritis, but with clusters of von Kossa-positive Michaelis-Gutmann bodies. The last two forms of the disease have not been previously reported to occur in the kidney. We believe that these cases represent various stages of development of the disease.
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4/11. Renal cell carcinoma with malakoplakia.

    We report a case of an elderly female with a history of long-standing urinary tract infection, who developed sudden macroscopic hematuria. A renal clear-cell carcinoma with diffuse pyelonephritis and malakoplakia was discovered at nephrectomy. This is the first neoplasia of the kidney associated with malakoplakia ever published.
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5/11. Malakoplakia of the female genital tract.

    A rare case of malakoplakia of the uterine cervix and the pelvis occurring in an elderly woman who also had xanthogranulomatous pyelonephritis is described and compared with the 15 reported cases of malakoplakia of the female genital tract.
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keywords = pyelonephritis
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6/11. Alpha-1-antitrypsin in malakoplakia.

    macrophages in malakoplakia contain large amounts of immunoreactive alpha-1-antitrypsin (AAT). The amount of AAT remains unchanged during the morphogenetic stages of the pathological process (early, granulomatous, fibrosing phases), and does not correlate with the number or the presence of Michaelis-Gutmann (M.G.) bodies. macrophages from other pathological processes, closely resembling malakoplakia cells but without M.G. bodies, did not contain AAT, except for a few macrophages in tuberculosis and xanthogranulomatous pyelonephritis. Whatever the source and the pathogenic role of AAT in malakoplakia, its presence in all macrophages seems to be specific for this disease. Immunohistochemical staining for AAT is therefore proposed as a useful test for an early and accurate differential diagnosis of malakoplakia.
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keywords = pyelonephritis
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7/11. malacoplakia of the kidney: apparent improvement following medical management.

    malacoplakia of the kidney is a rare histopathologic entity of unknown etiology. patients may present with a renal mass or with urinary tract infection. The prognosis has been uniformly poor excepting in those patients with unilateral involvement treated by nephrectomy. A 31 year old woman presented with acute renal failure and pyelonephritis. Renal biopsy revealed an interstitial infiltrate of large histiocytic cells with intracytoplasmic PAS-positive granules and calcospherules, findings consistent with malacoplakia. Following antibiotic treatment and dialysis, the patient has had a gradual improvement in renal function.
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keywords = pyelonephritis
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8/11. Pathologic and immunologic considerations in malakoplakia.

    A case of malakoplakia of the kidney is presented. Purified plasma membranes from the malakoplakia lesions stimulate blast transformation of the patient's autologous lymphocytes indicating the persistence of bacterial antigens which stimulate primarily thymus-derived lymphocytes. The skin test immunologic competence of the patient and the peripheral blood monocyte chemotactic response were normal. The pathologic findings and these immunologic studies are discussed in relation to xanthogranulomatous pyelonephritis and megalocytic interstitial nephritis and the pathogenesis of this disease.
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9/11. Megalocytic interstitial nephritis, xanthogranulomatous pyelonephritis, and malakoplakia. An ultrastructural comparison.

    light-microscopic and ultrastructural examinations of megalocytic interstitial nephritis, xanthogranulomatous pyelonephritis, and malakoplakia of the kidney were compared. The cases of megalocytic interstitial nephritis and xanthogranulomatous pyelonephritis represent the first reported electron-microscopic studies on human kidney of these diseases. The study confirmed the presence of a polymorphous cellular infiltrate with predominate histiocytes containing crystalloid material in the case of megalocytic interstitial nephritis; a polymorphous cellular infiltrate with histiocytes predominating in the case of xanthogranulomatous pyelonephritis; and macrophages containing Michaelis-Gutmann bodies in the case of malakoplakia. The characteristic sites of involvement within the kidney by each of the three lesions are discussed. It is believed that the lesions are distinct entities, but related to one another, and represent varied and unusual host responses to inflammation.
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keywords = pyelonephritis
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10/11. Renal malacoplakia with secondary hepato-duodenal involvement.

    Renal parenchymal malacoplakia is uncommon, and coexistence of extensive invasion into the liver and duodenum is extremely rare. Typically, there is an associated long-term urinary tract infection. We report on a 53-year-old woman with a history of diabetes and recurring pyelonephritis, who presented with a renal tumor and upper gastrointestinal bleeding. Surgical intervention included radical nephrectomy, lymphadenectomy, segmental hepatectomy, cholecystostomy, duodenorrhaphy, jejunostomy and appendectomy. There was no surgical morbidity. A pathologist confirmed the diagnosis of malacoplakia. All of the diagnostic criteria, including hematoxylin and eosin stain, iron stain, calcium stain and electron microscopy of Michaelis-Gutmann bodies, were classic. The literature is reviewed.
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