Mass lesions in the transplanted kidney: Answers

Malakoplakia after kidney transplantation: Case report and literature review

“…52 This granulomatous reaction generates the appearance of lesions, which range from plates to nodules and yellow-brown masses; histologically, the injury has aggregates of inflammatory cells, histiocytes, or macrophage-type cells, The diagnosis is based on histological features; however, imaging studies may suggest its etiology and also guide the best place for sampling. In computed tomography, lesions may have solid and cystic components, 10 as well as septa, 18 showing a hyperdense and calcified appearance, and they can be enhanced with contrast; in magnetic resonance, it is characterized by a low signal intensity; these changes are related to the presence of calcium and iron in the Michaelis-Gutmann bodies 11,29,53 ; however, non-calcified masses have been described in the same type of image. 32 When the involvement is located in the renal parenchyma, evaluation with scintigraphy has been associated with decreased uptake of technetium-99m in the affected area, with an increased uptake of gallium 67.…”

“…Based on our literature review, it was more prevalent in women (61.1% of cases), and it has been described from the early days of transplantation and up to 15 years later (median 24 months p25‐75: 12.75‐69 months) (Table ). We found that malakoplakia was reported more often in kidney transplantation, and the most common form is involvement of isolated renal parenchyma, where it usually presents as r‐UTI and graft dysfunction in up to 74% of cases, as a pseudotumoral mass in up to 33% of cases, followed, in order of frequency, by compromise of kidney and bladder, GI tract, colon, cecum, rectum, and the perianal region. In the latter cases, fistulas are present, as well as pseudotumoral lesion; and at least one case was associated with chronic diarrhea, plus an asymptomatic case .…”