Renal malakoplakia presenting as a renal mass in a 55-year-old man: a case report

Abstract

IntroductionMalakoplakia is an uncommon chronic inflammatory condition that has a gross and microscopic appearance resembling that of xanthogranulomatous pyelonephritis. It is characterized by distinctive Michaelis-Gutmann bodies. Malakoplakia can affect any organ system but genitourinary tract involvement is the most common, particularly in immunocompromised individuals. Very rare cases have been reported to present as a unifocal lesion mimicking a renal tumor.Case presentationWe report a case of renal malakoplakia in a 55-year-old Iranian man with a past history of recurrent urinary tract infections who presented with left flank pain. An ultrasound study showed a large solid left renal mass, and he underwent a left radical nephrectomy with a clinical diagnosis of a renal tumor. Pathology slides revealed the diffuse infiltration of sheets of Periodic Acid Schiff-positive histiocytes in his renal parenchyma; these cells showed strong immunoreactivity for CD 68. The final diagnosis was renal malakoplakia.ConclusionRenal malakoplakia must be kept in mind for patients presenting with a renal mass and a history of long-term recurrent renal infections or renal failure. The large, rapidly growing nodules of malakoplakia may mimic renal cell carcinoma in imaging studies. In these cases, a true cut needle biopsy may help the correct diagnosis and prevent unnecessary surgery.

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

“…Michaelis and Gutmann were the first to define malakoplakia in 1902. In 1903, Hansemann coined the term malakoplakia, which was derived from a combination of malakos (soft) and plakos (plaque) in ancient Greek [ 4 , 5 ]. Malakoplakia of the prostate was defined for the first time by Carruthers in 1959.…”

A rare renal malakoplakia mimicking renal tumor presenting with deep vein thrombosis and bilateral pulmonary embolism in a 58-year-old woman

“…Surgical excision is the choice treatment of unifocal disease, and nephrectomy is indicated when damage to the kidney is extensive. 1 , 2 , 3…”

“…It was first described in 1901 by von Hansemann and then were first published by Michaelis and Gutmann in 1902. 1 …”

Renal malakoplakia mimicking a malignant renal carcinoma: a patient case with literature review

“…Treatment of malakoplakia is contingent on the extent of the disease and the underlying conditions of the patient 7. Typically, patients with bilateral or multifocal diseases are cured after using antibiotics, including quinolones, rifampin, doxycycline and vancomycin 8.…”

“…Typically, patients with bilateral or multifocal diseases are cured after using antibiotics, including quinolones, rifampin, doxycycline and vancomycin 8. In addition, a cholinergic agonist, such as bethanechol chloride, is used in combination with antibiotics to correct lysosomal defects 5 7. Surgical excision is the choice treatment of unifocal diseases;4 but nephrectomy is indicated when the disease extends into the upper, mid and lower poles of the kidney—when damage to the kidney is extensive 8…”