Endoscopic mucosal resection of a rectal malakoplakia in a healthy adult

Abstract

Malakoplakia in the gastrointestinal tract is rare in healthy young people without underlying disease. Sufficient tissue is required for accurate diagnosis. We describe a malakoplakia that developed in a healthy young woman and was treated by endoscopic mucosal resection (EMR). A 40-year-old woman with a history of taking oral contraceptives until one year earlier was referred to our hospital with anal bleeding and constipation. A colonoscopy carried out at our another hospital 18 months earlier disclosed no abnormal findings. Colonoscopy at presentation revealed a yellowish-white tumor, 5 mm in diameter, in the rectum. The lesion was slightly protruded and had a smooth flat surface, without erosion or ulceration. EMR was carried out for a definitive diagnosis. Histopathological examination showed that the tumor contained granular histiocytes, positive for CD68 and negative forcytokeratin (AE1/AE3). Several histiocytes contained intracytoplasmic round bodies (Michaelis-Gutmann bodies), which reacted positively with periodic acid-Schiff and calcium (Von Kossa) stains. Intracytoplasmic Escherichia coli (von Hansemann bodies) were identified by Giemsa staining. Based on these results, the tumor in the rectum was diagnosed as a malakoplakia. Following EMR, the patient did not receive further treatment for malakoplakia because she had no symptoms associated with malakoplakia. She has been well for more than 9 months, with no symptoms of disease. Awareness of colorectal malakoplakia is important in patients taking steroids, including oral contraceptives.

Chronic Diarrhea Related to Colonic Malakoplakia Successfully Treated with Budesonide in a Kidney Transplant Recipient

“…Treatment options include the reduction of the immunosuppressive regime, and the use of cholinergic agonists such as bethanechol, and ascorbic acid to improve macrophage function. Long-term use of antibiotics (trimethoprim/sulphamethoxazol, ciprofloxacin, and rifampicin) have also been used with some success, as well as endoscopic or surgical excision of the lesion [1][2][3][4][5]. In the current patient, the diarrhea did not improve with the modification of immunosuppressive agents.…”

Rectal malakoplakia simulating a locally advanced rectal cancer: a case report

“…3 It is hypothesized that a defect of macrophage phagolysosomal response to bacterial infection is the cause of malakoplakia. [1][2][3][4][5] The involvement of microorganisms is supported in patients with malakoplakia who have chronic infections with various organisms such as Escherichia coli, Proteus mirabilis, Staphylococcus aureus and Mycobacterium tuberculosis. Nevertheless, other factors contribute to the development of malakoplakia.…”

“…1 It was first reported by Michaelis and Gutmann in 1902 and in 1903 named by Von Hansemann. [1][2][3][4] The term malakoplakia stems from the Greek Malakos (soft) and Plakos (plaque) and reflects its usual appearance as a friable and yellow mucosal lesion on endoscopy. 1,2 It is hypothesized that a defect of macrophage phagolysosomal response to bacterial infection is the cause of malakoplakia.…”

Malakoplakia mimicking a locally advanced colorectal neoplasm

“…Clinical diagnosis is uncommon. Differential diagnosis of malakoplakia is broad, including conditions like solid neoplasms, inflammatory bowel disease, xanthogranulomatous pyelonephritis, tuberculosis and Whipple disease [ 1 , 2 , 5 , 7 , 8 ]. Radiological findings are also highly unspecific [ 4 , 9 ].…”

“…Surgical resection is indicated in cases of extensive organ infiltration, marked symptoms and/or suspected malignancy. Endoscopic resections have been described in cases of localized lesions [ 7 , 13 ].…”