Malakoplakia: an update on pathophysiology and a review of the last ten years

Abstract

Purpose: Malakoplakia is an unusual chronic inflammatory condition affecting predominantly the genitourinary tract with special affinity for the bladder. A strong association with infectious processes and immunosuppression is well known. On several occasions, malakoplakia presents as a doubtful lesion misleading clinicians toward a suspicious of tumour. The aim of this review and analysis of the literature is to contribute to clarify the biological behaviour and prognosis of malakoplakia and to establish some key points in the clinical and surgical management. Methods: A Medline (2008-present) database searches yielded 26 references. Results: Most cases occurred in the fifth and sixth decades of life, with a mean age at diagnosis of 50 years old. Analyses of the literature revealed a strong female predominance just for bladder localization with a male/female ratio 1 : 4. Malakoplakia has been reported to occur at various sites, most commonly in the urinary tract in at least 70% of cases, with isolated reports in the gastrointestinal tract, central nervous tissue, skin, hepato-biliary tract, pancreas, liver, lymphnodes, respiratory tract, adrenal gland, vagina, brain, lung and bones. Conclusions: Malackoplakia could be managed by a combined medical and surgical approach and is clinically prudent to exclude a cancer when diagnosed.