Malakoplakia of the pancreas with diffuse lymph-node involvement

Abstract

We report a case of malakoplakia involving the pancreas in a 74-year-old man with associated regional lymphoadenopathy. Histological examination of both pancreas and lymph nodes revealed a diffuse histiocytic infiltrate containing numerous Michaelis-Gutmann bodies. Electron microscopy supported the diagnosis of malakoplakia and showed bacterial-like structures. Differential diagnosis includes myofibroblastic inflammatory tumor and histiocytic neoplasms. Lymph-node involvement during malakoplakia is extremely rare and it has never been documented microscopically. Lymphohematogenous spread of bacteria may be the cause of the nodal involvement, which, however, does not appear to influence the clinical course of the disease.

Coexistence of renal malakoplakia and myelodysplastic syndrome

“…Lymph node MPK has been reported. 3 Lymph node biopsy of our patient was discretely inflammatory with neither lymphoma nor nodal MPK involvement. MPK affects mostly patients who are immunosuppressed, debilitated and with chronic conditions, such as cancer, diabetes, alcohol liver disease, tuberculosis, AIDS.…”

“…Lymph node MPK has been reported 3 . Lymph node biopsy of our patient was discretely inflammatory with neither lymphoma nor nodal MPK involvement.…”

Malakoplakia of the Pancreas with Simultaneous Colon Involvement: Case Report and Review of the Literature

“…Our case may be the fourth in a series of case reports detailing systemic involvement by malakoplakia. Previous reports include a 49-year-old male who presented with retroperitoneal malakoplakia and subsequent bone involvement [ 3 ], a 6-week-old male with congenital immunodeficiency who presented with appendiceal and colonic malakoplakia, in addition to pancreatic involvement [ 5 ], and a 74-year-old male with pancreatic tail involvement by malakoplakia, along with spread to the peripancreatic lymph nodes [ 6 ].…”

“…Relevant findings in these case reports are summarized in Table 1 . Two patients [ 6 , 7 ] presented with abdominal pain prompting further evaluation, while, in one patient, it was detected incidentally during elective cholecystectomy [ 1 ]. One of the patients described by Colby [ 3 ] was diagnosed with malakoplakia (secondary to Corynebacterium equi and Klebsiella ) which presented as a retroperitoneal mass with additional involvement of the pancreatic tail and mesenteric root of the transverse colon.…”

“…Zuk et al [ 7 ] described a patient with concurrent malakoplakia and moderately differentiated adenocarcinoma of the pancreas with widespread metastasis of the tumor and subsequent demise of the patient. Reports of malakoplakia involving lymph nodes have been described [ 6 , 8 ] and it appears that diffuse lymph node involvement is usually more commonly seen in immunocompromised patients. The significance of lymph node involvement by malakoplakia is uncertain at present with some reports describing a poor prognostic implication [ 8 ], while in others [ 6 ] the patients have an uneventful postdiagnosis period.…”