Malakoplakia, a malignant mimic

Abstract

Malakoplakia is a chronic inflammatory condition that affects multiple systems, most commonly the urogenital tract. Its clinical presentation is often non-specific, but is typically characterized by recurrent urinary tract infections and haematuria. We report a rare case of intravesical malakoplakia mimicking an aggressive transitional cell carcinoma both in its clinical presentation and in its macroscopic appearance on cystoscopy in an 82-year patient, the oldest reported case in the literature. Malakoplakia has been described in the literature as a benign disease process presenting typically in younger patients. This case demonstrates its ability to cause obstructive uropathy and affect elderly patients. Thus, this case serves as a reminder to consider malakoplakia as a differential in the evaluation of suspected bladder malignancy in patients of all ages.

Keywords: malakoplakia; obstructive uropathy; transitional cell carcinoma.

Figure 1.

Computed tomography—coronal (A) and axial (B) planes demonstrating bilateral hydroureteronephrosis and a bladder mass at the base measuring 13 mm.

Figure 2.

Right retrograde pyelogram revealing multifocal filling defects within the right ureter (A) and right sided hydronephrosis with ureteric stent in situ (B).

Figure 3.

Low (A) and high powered (B) von Kossa calcium stains of the bladder biopsy revealing a mixed inflammatory infiltrate and the presence of von Hansemann histiocytes (blue and yellow arrows) with Michaelis-Gutmann bodies (green arrow).