Gallbladder malakoplakia in type 2 diabetes mellitus: a rare entity

Abstract

Gallbladder malakoplakia in type 2 diabetes mellitus is a rare condition. Differentiating malakoplakia, which is a more aggressive disease condition with possible genetic abnormality from a more benign but closely related condition such as xanthogranulomatous cholecystitis, is of prognostic importance in postoperative patient management and follow-up.

Malakoplakia of Gall Bladder: A Histological Surprise

“…By mimicking carcinoma gall bladder Malakoplakia has influenced treatment protocol in several previous case reports [1,2,9], like compelling frozen section as in our case or performing aggressive and extended resections. Post operatively Malakoplakia requires specific chemotherapy that concentrates in macrophages such as quinolone, trimethoprimsulfamethoxazole [2].…”

“…By mimicking carcinoma gall bladder Malakoplakia has influenced treatment protocol in several previous case reports [1,2,9], like compelling frozen section as in our case or performing aggressive and extended resections. Post operatively Malakoplakia requires specific chemotherapy that concentrates in macrophages such as quinolone, trimethoprimsulfamethoxazole [2]. Bethanechol, a choline agonist, has been used in Malakoplakia [10] with the concept that bethanechol may correct the decreased cGMP levels that are important for microtubular and lysosomal function in macrophages [5].…”

“…It can also affect the other parts of the body such as gastrointestinal, genital, and biliary tracts, central nervous system and skin. Pathologically, on gross examination, Malakoplakia has characteristic appearance of soft yellow plaques or nodules [2]. Microscopically, it is characterized by the presence of sheets of mononuclear cells with granular cytoplasm (von Hansemann cells).…”

“…Malakoplakia, xanthogranulomatous cholecystitis, aggressive inflammation and carcinoma gallbladder can produce similar features on imaging [1] thus making preoperative diagnosis is often impossible. To add to the diagnostic dilemma are the intraoperative features of hard mass with extensive infiltration into liver and surrounding organs such as duodenum and colon [2]. Surgeons would often consider carcinoma as the first differential and perform extensive resection to err on the safer side.…”

Clinical Analysis of Renal Failure Caused by Malakoplakia: A Case Report and Literature Review

“…Some studies have also reported that the combination of sulfonamides or rifampicin with quinolone therapy increases the anti-infective effect. Recently, it has also been suggested that cholinergic agents such as methine choline combined with vitamin C can increase the intracellular cGMP/cAMP ratio in macrophages, thereby improving intracellular lysosomal function in macrophages, and it is effective in patients with malakoplakia ( 13 , 14 ).…”