Malakoplakia of the vagina diagnosed by fine‐needle aspiration cytology

Abstract

Malakoplakia is an uncommon chronic granulomatous process that most commonly affects the urinary tract, but it may rarely recur in the female genital tract. It appears to result from a defect in macrophage function resulting in an inability to destroy ingested bacteria. We describe the fine needle aspiration cytology of malakoplakia in a 84-yr-old woman presenting with a large pelvic mass involving the apex of the vagina. The patient's history was significant for cervical squamous cell carcinoma in the remote past. CT-guided needle aspiration yielded cellular smears with large numbers of isolated histiocytes, as well as polymorphonuclear leukocytes, lymphocytes, and plasma cells. The histiocytes had central nuclei and abundant granular cytoplasm containing target-shaped, laminated bodies (Michaelis-Gutmann bodies). These bodies were PAS positive and focally von Kossa positive. Large numbers of intracellular and extracellular bacteria were also seen on the smears. The characteristic cytologic findings obtained by needle aspiration were diagnostic of malakoplakia with a rare and unusual clinical presentation.

Malakoplakia of Bone

“…2 Thus, stains for iron and calcium show a positive reaction, and in some cases intracellular bacilli are seen. 5 Similar findings were present in our case.…”

Pulmonary Malacoplakia Associated with <i>Rhodococcus equi </i>Infection in an AIDS Patient

“…3,17,19 Therefore, the current case was unique in visually demonstrating R equi in the malacoplakia lesion by FNA: all the previously reported cases of malacoplakia with R equi infection were diagnosed on tissue sections obtained by either bronchial biopsy (two cases) or lobectomy (one case). Cytologic features of malacoplakia seen in our case were more or less similar to what has been reported by other authors 2,5,8,13,14 and included the presence of numerous histiocytes with distinctly reticulated or granular cytoplasm and a small, eccentrically located nucleus containing targetshaped MG bodies. These pathognomonic bodies, in the experience of most authors, are easily recognizable on Papanicolaou stain, Diff-Quik and hematoxylin-eosin.…”

“…5 The histopathologic features of malacoplakia have been well illustrated in the literature. Diagnosis of malacoplakia on cytologic preparations has been reported for urine sediments, 10 needle aspiration, 2,5,8,13,14 vaginal scrapes, and bronchial, 4 and gastric 7 brushing. To our knowledge, this is the first case of pulmonary malacoplakia with R equi infection in an acquired immunodeficiency syndrome (AIDS) case diagnosed by fine needle aspiration.…”

Diagnosis of Renal Malacoplakia by Fine Needle Aspiration Cytology

“…11,15 The kidney is involved in approximately 15% of cases, with 75% of these affecting women. 5,15 Fine needle aspiration (FNA) diagnosis of malacoplakia has been reported for the thyroid, 7 gastrointestinal tract, 1,9 skin, 4 vagina, 14 pelvis, 12 prostate, 3,13 lymph nodes 8 and lung. 16 To our knowledge this is the first report of renal malacoplakia diagnosed by fine needle aspiration.…”