Appendiceal malakoplakia masquerading as a cecal mass

Abstract

Appendiceal malakoplakia masquerading as a cecal mass is uniquely rare. The presence of an infiltrate of granular eosinophilic macrophages containing Michaelis–Gutmann bodies on histopathology is pathognomonic of malakoplakia. Cutaneous, gastrointestinal and most commonly urogenital malakoplakia is reported in association with an immunocompromised state, infectious, inflammatory and neoplastic processes. Presentation varies from microscopic disease to plaques, nodules, polypoid lesions and small masses. However, a cecal mass postea proven appendiceal malakoplakia deserves special attention. We could not find similar case reports in the English literature. The pathogenesis of malakoplakia is poorly understood, and it is unclear if it is a harbinger of malignancy, a precursor lesion or an inflammatory marker. In the setting of a dominant appendiceal mass, post-treatment endoscopic and tumor marker surveillance is paramount but, however, undefined in contemporary literature.

A Surgical Challenge Generated by Colonic Malakoplakia in Disguise as a Locally Advanced Colonic Malignancy—A Case Report

“…At this moment, there is no therapy considered the gold standard for this rare disease. Therapeutic alternatives are: antibiotic therapy using agents that interact directly with the macrophages, like the quinolones or trimethoprim-sulfamethoxazole diminution or even suspension of the doses prescribed for the immunosuppressive therapy a good control of the associated immunosuppressive pathology endoscopic resections for the cases with localized lesions surgical resection for the cases that present multiple organ infiltration and or suspected malignancy [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. …”

“…surgical resection for the cases that present multiple organ infiltration and or suspected malignancy [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Pancreatic Malakoplakia: A Rare Pathology Associated With Acute Pancreatitis

“… 12 Although much about the pathogenesis remains unknown, inflammatory or neoplastic processes are believed to lead to immune dysregulation with abnormal lysosome function and subsequent chronic bacterial infection. 5 , 13 , 14 Immunocompromise secondary to malignancy, steroids, chemotherapy, HIV, poorly controlled diabetes, and solid-organ transplant has been seen to facilitate this phenomenon. 3 , 4 , 13 , 15 This case reported here is a unique presentation of pancreatic malakoplakia in a patient without any prior evidence of immunocompromise developing after bouts of necrotizing pancreatitis.…”

“…Malakoplakia in the gastrointestinal tract has previously been associated with colorectal malignancy, but has also been described in the liver, stomach, and pancreas. 4 , 14 , 16 Although imaging is helpful, the diagnosis must be confirmed by histologic examination. Cross-sectional imaging of the abdomen and pelvis, including computed tomography scan, often shows a nonspecific inflammatory process or tumor-like mass.…”

Cecal malakoplakia: A case report

“…Three cases were diagnosed by fine-needle aspiration and mass was resolved after receiving medical treatment involving antibiotics and/or bethanechol without surgical treatment. Three cases took only surgical treatment and two cases were received medical treatment after en bloc resection [8][9][10][11][12][13][14][15]. In spite of small number of cases, malakoplakia was well treated by only medical treatment involving antibiotics and cholinergic drugs.…”