Malakoplakia: Pathogenesis and ultrastructural morphogenesisA problem of altered macrophage (phagolysosomal) response

Lou, Te Young; Teplitz, Carl

doi:10.1016/s0046-8177(74)80066-3

Cited by 195 publications

(86 citation statements)

References 26 publications

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“…[13][14][15][19][20][21][22] Our findings are also consonant with the concept that the abundant eosinophilic and granular cytoplasm of the malacoplakic histiocytes is due to the presence of large numbers of phagolysosomes. The Michaellis-Gutmann bodies are derived from calcification within some of the larger phagolysosomes.…”

Section: Electron Microscopic Findingssupporting

confidence: 86%

“…More recently, several ultrastructural studies have demonstrated the presence of bacteria such as E. coli, Klebsiella, S. aureus, and Mycobacterium intracellularis in various stages of degradation within the phagolysosomes of the malacoplakia. 7,9,[13][14][15] This suggests that in malacoplakia, the histiocytes can phagocytose the bacteria normally, but somehow their capability to kill and digest bacteria is defective. Because the bactericidal action of the macrophages is usually carried out in the phagolysosomes, a defect in their function has been postulated.…”

Section: Electron Microscopic Findingsmentioning

confidence: 99%

“…Because the bactericidal action of the macrophages is usually carried out in the phagolysosomes, a defect in their function has been postulated. 13 In a detailed study of macrophage function in malacoplakia, Abou, et al demonstrated that the blood monocytes in patients with malacoplakia had decreased levels of cyclic guanosine monophosphate (GMP). 11 Cyclic GMP is essential for normal fusion of lysosomes with phagocytic vacuoles with subsequent release of lysosomal enzymes in the resulting phagolysosomes.…”

Section: Electron Microscopic Findingsmentioning

confidence: 99%

“…Similar bacillary bodies have been seen in some but not all of the previous ultrastructural studies. [13][14][15][19][20][21][22] It is now generally agreed that these represent bacteria phagocytosed by the histiocytes. It is not clear, however, why these bacteria can be easily demonstrated in some cases but not in others.…”

Section: Electron Microscopic Findingsmentioning

confidence: 99%

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Malacoplakia of the Colon and Rectum: Report of Two Cases and Review of the Literature

et al. 1982

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Malacoplakia of the colon and rectum is uncommon with only 30 cases having been reported in the literature. This paper documents two additional cases involving the colon and rectum. The first patient had extensive disease involving virtually the entire rectum and colon and portions of the terminal ileum. The clinical course was marked by several perianal and cutaneous fistulae and repeated abscesses in the retroperitoneum. The second case had more limited disease involving the left and transverse colon. Lesional tissues from both cases were studied by light and electron microscopy. Light microscopic appearance was characterized by the presence of large numbers of histiocytes with typical intracytoplasmic Michaelis-Gutmann bodies. Ultrastructurally, the histiocytes had numerous phagolysosomes and several Michaelis-Gutmann bodies seen as round structures with concentric rings of calcification. These appeared to be derived from large phagolysosomes. In one of our cases, intracytoplasmic clusters of bacillary bodies were also seen within malacoplakic histiocytes.

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Section: Electron Microscopic Findingssupporting

confidence: 86%

Section: Electron Microscopic Findingsmentioning

confidence: 99%

Section: Electron Microscopic Findingsmentioning

confidence: 99%

Section: Electron Microscopic Findingsmentioning

confidence: 99%

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Malacoplakia of the Colon and Rectum: Report of Two Cases and Review of the Literature

et al. 1982

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“…Partially digested bacteria accumulate in macrophages and lead to deposition of calcium and iron on residual bacterial glycolipid. The resulting basophilic structure, the Michaelis-Gutmann body, is considered pathogomonic for malakoplakia [6,7,10].…”

Section: Discussionmentioning

confidence: 99%

Malakoplakia of the Urinary Tract: A Benign Disease with a Possible Malignant Outcome

Wong¹,

Yeung²,

Lee³

et al. 2016

JCR

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Abstract:Introduction: Malakoplakia is a rare chronic inflammatory disease which commonly affects the urogenital tract. The exact pathogenesis is not fully understood, but some associated conditions which include immunodeficiency, malignancy or chronic bacterial infection, have been suggested. The definite diagnosis relies on identifying the Michaelis-Gutmann bodies microscopically. Case Report: A 62-year-old woman with poorly controlled diabetes mellitus presented with gross hematuria for a few months. Subsequent investigations showed a positive urine culture (Escherichia coli -E. coli), and flexible cystoscopy showed a 1 cm plaque-like lesion at the left posterior wall of the urinary bladder as well as several smaller, similar lesions noted at various different sites. Biopsy of the lesion showed a proliferation of macrophages (CD68+) with abundant, glandular cytoplasm and the presence of Michaelis-Gutmann bodies (PAS+, Von Kossa+), which was consistent with malakoplakia. Computed Tomography (CT) urogram showed no hydronephrosis, with good contrast excretion from both kidneys as well as satisfactory drainage down to the bladder. She was then treated with antibiotics, but still had on and off urinary tract infection. About a year later, she presented with urosepsis and acute renal failure, and was admitted to the urological ward. Urgent CT urogram showed bilateral hydronephrosis with both lower ureters distended with hyperdense contents (malakoplakia plaques). Emergency bilateral percutaneous nephrostomy (PCN) was performed. Her condition was stabilized with antibiotics, and her renal function improved with PCN drainage. Several treatment options were offered to the patient, but in view of her significant pre-morbid condition, she opted for bilateral long-term PCN. Conclusion: Malakoplakia was thought to be a treatable and relatively benign disease, but in some cases, it might result in renal failure due to bilateral ureteric involvement. Early diagnosis together with adequate antibiotic treatment is important in patients with malakoplakia, and they should be closely followed up to prevent future development of renal insufficiency.

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Renal parenchymal malakoplakia. A case associated with renal vein thrombosis and partial recovery of kidney function

García-García¹

1980

Archives of Internal Medicine

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A 65-year-old woman with bilateral renal parenchymal malakoplakia and renal vein thrombosis had severe azotemia, bilaterally enlarged kidneys, urinary tract infection, and sepsis. Angiographic studies demonstrated left renal vein thrombosis. A percutaneous kidney biopsy specimen showed the characteristic Michaelis-Gutmann bodies. After therapy with fluid replacement, antibiotics, and long-term anticoagulation, kidney function improved and both kidneys decreased in size. We suggest that, with adequate treatment of urinary tract infection and correction of potential insults to the kidney, progression of this peculiar disease can be prevented.

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Malakoplakia: Pathogenesis and ultrastructural morphogenesisA problem of altered macrophage (phagolysosomal) response

Cited by 195 publications

References 26 publications

Malacoplakia of the Colon and Rectum: Report of Two Cases and Review of the Literature

Malacoplakia of the Colon and Rectum: Report of Two Cases and Review of the Literature

Malakoplakia of the Urinary Tract: A Benign Disease with a Possible Malignant Outcome

Renal parenchymal malakoplakia. A case associated with renal vein thrombosis and partial recovery of kidney function

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