Malakoplakia of the Pancreas with Simultaneous Colon Involvement: Case Report and Review of the Literature

Abstract

Although malakoplakia has been reported to occur at various body sites, pancreatic malakoplakia with simultaneous colonic involvement is very rare. Lesions of malakoplakia can masquerade as tumor masses leading to unwanted resections. Nevertheless, malakoplakia can occur in association with frank carcinomas, especially in the colon. By reporting a case of pancreatic malakoplakia diagnosed by fine needle aspiration cytology, this paper aims to describe cytologic features of malakoplakia and to further review findings from previous reported cases of pancreatic malakoplakia in the literature. With advances in minimally invasive, image-guided aspiration technologies, cytomorphological analyses can diagnose lesions of malakoplakia. This may help avoid surgeries that would have otherwise been carried out due to a misleading impression of tumor. However challenges remain as to the further management of patients diagnosed with this condition. More studies are necessary to determine the probability of malignancies arising in association with malakoplakia, in order to devise appropriate treatment protocols.

Malakoplakia in a colonic tubular adenoma: a unique case presentation

“…The word malacoplakia was suggested by Professor von Hansemann himself, and it was derived from Greek words malakos (soft) and plakos (plaque) [3]. The mode of the occurrence in relation to age is characterised by bimodal pattern, the first prevalence is below age of 13 and the second group is the middle -aged adults, however the average age at diagnosis is 50 years [12][13][14][15][16][17][18]. It has since been reported at other sites, including the gastrointestinal tract (GIT) [7,8,19], the skin [9], the vagina [10], the central nervous system [20], the lungs [21], pancreas [15] and the gallbladder [22].The second group is the middle-aged adults, however the average age at diagnosis is 50 years [12][13][14].…”

“…Clinical presentation varies from incidental finding during a procedure, to a symptomatic mass lesion. It has been commonly reported in cases involving the genitourinary tract (70%) [15], and most often in the urinary bladder [16], and it has been mistaken for malignancy [17]. Malakoplakia was first reported outside of the genitourinary system in 1958 by Haukohl and Chinchinian [23].…”

“…This nucleotide acts as a second messenger much like cyclic AMP (adenosine monopho-sphate), and it plays part in activation of intracellular protein kinases. The protein kinases are the enzymes which are helpful in phosphorylation of many proteins, among, them the immunoglobulins and lytic enzymes [14,15]. The macrophages are still able to engulf the bacteria, however unable to destroy them.…”

“…The outcome will be the presence of intracellular inclusion bodies, formed of undigested bacterial bodies, glycolipid, iron and calcium deposits, giving the appearance of Michaelis-Gutmann bodies (MGBs).These inclusion bodies usually stain positive with Von-Kossa and Prussian Blue stains. The association of the malakoplakia and the immunological conditions as immunodeficiency or immunosuppression as in transplantation has been reported [14,15]. Malakoplakia found within the genitourinary tract is most often associated with an Escherichia coli infection.…”

Renal malakoplakia mimicking a malignancy and diagnosed by fine‐needle aspiration: A case report

“…Rare cases have been reported to present as locally advanced renal mass and even rarer ones diagnosed by fine-needle aspiration (FNA) cytology. [4][5][6][7][8][9][10][11][12][13][14] We, herein, present a case of renal malakoplakia clinically and radiographically mimicking as a locally advanced malignancy and diagnosed initially by FNA cytology.…”