Case study: Malakoplakia of the bladder

Abstract

ObjectivesMalakoplakia is a rare chronic inflammatory disease thought to be the result of defective bacterial phagocytosis and lysosome function, and there is difficulty in accurate diagnosis as a result of non-specific symptoms that mimic other diseases and cancers. This study presents a case of bladder malakoplakia associated with renal failure presenting as a tumor. MethodsA 55-year-old woman with history of kidney disease who presented with general malaise and worsening renal failure was found to have a bladder mass and underwent transurethral resection of bladder tumor (TURBT), and subsequent histological examination. ResultsThe bladder mass consisted of basophilic structures known as Michaelis-Gutmann bodies within clusters of macrophages on histological examination, and stained positive for CD68. Von Kossa stain highlights Michaelis-Gutmann bodies, consistent with the diagnosis of malakoplakia. ConclusionsConservative treatment via antibiotics has been effective. Proper diagnosis of bladder malakoplakia is important, as the conditions it mimics often require surgery and resection. Additionally, it is important to recognize the implications bladder malakoplakia has on renal functioning, particularly regarding urinary obstruction.