Vaginal Malakoplakia

Abstract

Malakoplakia is a rare chronic inflammatory disease that predominantly develops in the urogenital system. Although its clinical presentation can vary from asymptomatic to urgent depending on location, mass effect, and other factors, its gross appearance can be mistaken for malignancy. However, the histological identification of von Hansemann histiocytes and Michaelis-Gutmann bodies confirm the diagnosis of malakoplakia. We present a case of a female patient who sought medical care for acute pelvic discomfort attributed to urinary retention after urinary obstruction. Although the discovery of multiple masses within the vagina and pelvic cavity indicated a tumor, it was originally negative for malignancy. Histology of biopsy samples demonstrated Michaelis-Gutmann bodies mixed with lymphoid cells through immunohistochemical and periodic acid–Schiff stains, consistent with a diagnosis of malakoplakia. Despite negative cultures, multiple courses of antibiotics were given, but the mass progressed and caused urinary obstruction. After pelvic exenteration, lymphoma was diagnosed and treated. We review the current literature on malakoplakia in different body sites associated with infections and noninfectious diseases.