Isolated Gastric Malakoplakia – An Extremely Rare Condition

Abstract

Purpose: A 71-year-old African American man presented with dyspepsia, epigastric discomfort, diarrhea and weight loss for two months. There was no clinical evidence of immunodeficiency or malignancy. Upper gastrointestinal endoscopy revealed mild inflammation in the gastric antrum and body with a 5mm polyp in the body. Examination of the biopsy revealed lamina propria replaced by regular, small, round nuclei with eosinophilic cytoplasm containing Michaelis-Gutmann bodies diagnostic of gastric malakoplakia. A moderate number of Helicobacter pylori like organisms were seen on warthin starry stain. Colonoscopy revealed one cecal and one descending colon tubular adenoma. There was no evidence of malakoplakia or malignancy seen elsewhere. He was treated with lansoprazole, amoxicillin and clarithromycin and his symptoms resolved. Repeat gastroscopy after 4 months showed no evidence of malakoplakia or H.Pylori organisms. Malakoplakia is a rare inflammatory process characterized by a mass like accumulation of histiocytes and intracellular Michaelis-Gutmann bodies. It is associated with concomitant diseases such as leukemia, lymphoma, alpha chain disease, immunodeficiency, miliary tuberculosis, villous adenoma and carcinoma. Infectious agents have been implicated as the cause of malakoplakia in the majority of cases. It most frequently involves the urinary tract with the gastrointestinal tract being the second most frequent site. The principal sites involved are the descending colon, sigmoid and rectum. Isolated gastric malakoplakia is an extremely rare diagnosis with only three reported cases in the english literature so far. To our knowledge this is the first case reported showing an association with H.pylori infection with complete symptomatic and histologic resolution after treatment. Since malakoplakia mimics malignancy and is associated with colorectal carcinoma in 30% of the cases a thorough evaluation is essential.