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Case Reports
. 2022 Sep 13;15(9):e251254.
doi: 10.1136/bcr-2022-251254.

Renal malakoplakia with invasion of the liver and diaphragm: a patient case and literature review

Joel Grunhut  1 , Ricardo Oroz  2 , Shimron Brown  2 , Roozbeh Nazarian-Rostami  2
Affiliations
Case Reports

Renal malakoplakia with invasion of the liver and diaphragm: a patient case and literature review

Joel Grunhut et al. BMJ Case Rep. .

Abstract

Renal malakoplakia, a seldom seen chronic inflammatory condition, continues to elude medical, surgical, radiological and pathological specialists due to its mimicry of other renal pathologies and low incidence. The variable clinical manifestations and non-specific radiological findings of malakoplakia can be misleading, and ultimately require a pathological diagnosis. A literature review reveals an extremely low prevalence of renal malakoplakia, a handful of invasive renal malakoplakia cases and no reports of liver and diaphragmatic invasion. We present a case of a renal mass with liver and diaphragmatic invasion in a 59-year-old woman that deceived clinicians and radiologists until a pathological diagnosis of renal malakoplakia was performed. This case highlights the need of awareness for malakoplakia in the differential diagnosis for renal invasive and non-invasive masses. The need to await a surgical biopsy and pathological diagnosis is critical to ensure a correct diagnosis and avoid unnecessary surgery of the kidney.

Keywords: Pathology; Radiology; Renal intervention; Urinary tract infections; Urological surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Coronal CT of the abdomen demonstrating a renal mass of the right upper pole with adjacent invasion of the liver and diaphragm.
Figure 2
Figure 2
Axial MRI of the abdomen further delineating the infiltration extension into the liver.
Figure 3
Figure 3
Histiocytic cells with dense infiltrates containing the Michaelis-Gutmann bodies, which contain high PAS positivity and often show a targetoid appearance (arrow) (PAS stain, original magnification ×400). PAS, periodic acid–Schiff.
Figure 4
Figure 4
Von Kossa-positive Michaelis-Gutmann bodies (von Kossa, 400×).
Figure 5
Figure 5
Diagnostic and treatment timeline.
See this image and copyright information in PMC

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