Unexpected endometrial malacoplakia related to abortion and placental rests retention: a case report

Abstract

Background: Malacoplakia is a rare chronic inflammatory disease. The name derives from the Greek "μαλακός" meaning "soft" and "πλάξ" meaning "plaque", describing its usual macroscopic presentation as a friable yellow soft plaque. It was first described by von Hansemann in 1901 and by Michaelis and Gutmann in 1902. The urinary system is the most commonly involved site. Female genital tract involvement is extremely rare. Treatment is prevalently based on antibiotics with surgical intervention sometimes necessary. Prognosis is usually good, but relapse may frequently occur. Case presentation: This report illustrates the first case of endometrial malacoplakia in a 40 years-old patient who received endometrial curettage due to the retention of placental rests following an abortion. After conspicuous vaginal sero-hematic secretions, the patient received a further curettage. The histological examination did not show any retention of chorionic rests, but an endometrial and myometrial infiltration of histiocytes with large granular cytoplasm within a chronic inflammatory background. Immunoreactivity for CK-pool was negative, while CD68 immunostaining was strongly positive. Conclusions: Malacoplakia of endometrium is an extremely rare condition, with few cases reported in the whole international literature. In this paper, we present the first case associated to an abortion followed by endometrial curettage procedures. This rare disease should always be attentively examined, considering, among differential diagnoses, uterine neoplasms or physiological conditions such as cumulus of foamy macrophages in the endometrium.

Case report: A rare case of malacoplakia resembling a malignant tumor of the cervix: a case report and review of the literature

“…To date, there have been fewer than 40 reported cases of female genital malacoplakia, 14 of which were cervical malacoplakia (including this case); most of these patients presented with vaginal and endometrial soft spots, and ovarian and fallopian tube invasion was rarer ( 29 ). Malacoplakia involving the cervix, endometrium and vagina has similar clinical manifestations, mainly abnormal uterine bleeding, postmenopausal vaginal bleeding and increased secretions ( 30 ). The ultrasound characteristics of endometrial malacoplakia include anechoic fluid expansion in the endometrial cavity in the acute stage, irregular and heterogeneous thickening, and endometrial hypopogenicity in the chronic stage; gynecological examinations generally have no specific findings ( 31 ).…”

Malakoplakia mimicking a locally advanced colorectal neoplasm

“…Macroscopically, malakoplakia lesions may follow three patterns: single yellow mucosal plaques, multinodular or polypoidal lesions and/or large mass lesions [ 1 , 3 , 5 ]. Microscopically, the presence of Michaelis–Gutman bodies is pathognomonic for malakoplakia but not essential, since they can be absent in early phases of the disease [ 1 , 8 , 11 , 12 ]. Michaelis–Gutman bodies are granular basophilic structures and can be observed inside macrophages or, extracellularly, among collagen-produce fibroblasts [ 1 ].…”