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Malacoplakia

Created: 9/1/2006

 

Malacoplakia

Definition

  • Rare chronic inflammatory process which most commonly affects the urinary tract. Characterised by the formation of soft, yellowish raised plaques on mucous membranes which contain von Hansemann cells with Michaelis-Gutmann bodies

Epidemiology

  • Most patients are over 50
  • More common in females 4:1

Aetiology

  • Unknown
  • E-coli probably causative organism
  • Macrophage dysfunction has been demonstrated - are unable to completely lyse bacteria which are phagocytosed
  • Risk factors
    • Immunocompromised
    • Carcinoma
    • Coliform infections
    • Autoimmune disorders

Pathology

  • Involves urinary tract in 58% cases- most commonly bladder, renal parenchyma and ureter
  • Can affect any part of GU and GI tract, skin, lungs, bones, and mesenteric lymph nodes
  • Lesion is comprised of foamy macrophages (von Hansemann cells) containing Michaelis-Gutmann bodies which are pathognomic

Signs and symptoms (depends on site affected)

  • Bladder lesions- haematuria, recurrent UTI’s
  • Renal lesions – loin pain, mass, pyrexia
  • Ureteric lesions – obstruction
  • Non-specific symptoms of weight loss, anaemia, night sweats may occur with larger lesions

Investigations

  • Raised WCC, raised ESR and anaemia
  • Positive MSU

Radiology

  • CT – shows heterogenous non-enhancing masses
  • USS – may show renal enlagement
  • IVU – shows presents as enlarged kidneys with multiple filling defects NB unifocal lesions are indistinguishable from other neoplastic/inflammatory lesions
  • Gallium scintigraphy maybe useful

Treatment

  • Is aimed at the control of UTI’s
  • Antimicrobial prophylaxis forms the mainstay of treatment
  • The use of ascorbic acid and cholinergic agents, such as bethanechol has been reported – these may improve macrophage function via an increase in cGMP levels
  • Surgery may be indicated if the disease progresses in spite of antimicrobial treatment

Prognosis

  • Depends upon site and extent of disease
  • Overall mortality 15%

ArticleDate:20060109
SiteSection: Article
 
   
    
                                            



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