A Pitfall in Transrectal Prostate Biopsy: Malakoplakia Evaluation of Two Cases Based on the Literature Review

Abstract

Malakoplakia is a rarely seen inflammatory condition that is considered to develop secondary to a chronic Escherichia coli infection. Although malakoplakia usually affects the genitourinary tract, it may also be observed in the colon, stomach, lungs, liver, bones, uterus, and skin. Malakoplakia of the genitourinary system usually involves the bladder, whereas it may also affect the prostate along with the bladder. Malakoplakia of the prostate is very rare, and it may be clinically mistaken for prostatic malignancies. Definitive diagnosis is only possible through histopathological examination. This study elaborates on two patients who presented to our hospital in 2013 with high PSA levels. The primary clinical consideration was prostate carcinoma. However, these two cases were diagnosed as malakoplakia based on the results of histopathological analysis of the transrectal prostate biopsy specimen.

Exuberant Malakoplakia of the Prostate Presenting as Prostatic Abscesses in an Immunocompromised Patient

“…Despite the proximity of the prostate to the urinary bladder, malakoplakia of the prostate remains rare, with only 50 patients reported in the literature, often as individual cases or short case series. [1][2][3][4] Our patient's cystoscopy was unremarkable, similar to other patients in the literature. Usually, reported patients with prostatic malakoplakia had either unremarkable cystoscopic examination or demonstrated nonspecific cystitis, suggesting that prostatic malakoplakia often occurs in isolation.…”

“…His medical history was significant for cirrhosis of unknown origin, status postliver transplant 3 months before presentation, on multiple immunosuppressive drugs (tacrolimus, mycophenolate mofetil, and prednisone), and diabetes mellitus type 2. He reported four episodes of Escherichia coli-associated urinary tract infection after his liver transplantation, for which he was Departments of 1 Pathology, 2 Urology, and 3 Radiology, Emory University School of Medicine, Atlanta, Georgia, USA. The present material was not submitted anywhere else.…”