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Bladder
Cystitis
Malakoplakia
Author: Nat Pernick, M.D. (see Authors page)
Revised: 14 December 2009, last major update December 2009, UPDATE IN PROGRESS
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Rare chronic granulomatous condition of all organs, commonly GU tract, particularly bladder (Radiographics 2006;26:1847)
Terminology
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Epidemiology
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● More common in immunocompromised (HIV, renal transplant recipients) and women
Sites
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Etiology
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● Caused by defects in phagocytic or degradative functions of histiocytes in response to gram negative coliforms (E. coli or Proteus)
Clinical features
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● Rarely associated with calcified plaques (encrusted cystitis, Ir J Med Sci 2006;175:74) and renal failure (Nat Clin Pract Urol 2008;5:516)
Prognostic factors
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Case reports
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● 18 year old man with malakoplakia of bladder and ureter (Cases J 2009;2:7527)
● 76 year old woman with hematuria (Case of the Week #131)
Treatment
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● Antibiotics that concentrate in macrophages (quinolones or trimethoprim-sulfamethoxazole), antibiotics directed against E. coli plus surgery
● Possibly bethanechol (may correct decreased cGMP levels that may interfere with complete bacterial killing, eMedicine)
● Discontinuation of immunosuppressive drug therapy
Clinical images
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Gross description (Macroscopy)
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● Multiple 3-4 mm soft yellow plaques or nodular thickenings of bladder wall near trigone that resemble carcinoma
Gross images
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Micro description (Histopathology)
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● Foamy epithelioid histiocytes with PAS+ granular eosinophilic cytoplasm in lamina propria, some lymphocytes and occasional giant cells
● Histiocytes have increased number of phagosomes containing non-digested bacteria (usually E coli or Proteus), contain Michaelis-Gutmann bodies (iron containing, cytoplasmic laminated mineralized concretions)
● Late-fibrosis and scarring
Micro images
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Malakoplakia (arrows at Michaelis-Gutmann bodies)
Case of the week - #1; #2; #3; #4; #5; von Kossa stain; iron stain
Plaque-like lesion eroding the bladder mucosa, link
At higher magnification, the target-shaped Michaelis-Gutmann bodies (arrows) are prominent., #1, #2, #3, #4
von Kossa calcium stain #1; #2
CD68: #1
Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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● Macrophages have phagosomes that are packed with undigested bacterial products
Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● (link to topic)
Additional references
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End of Bladder > Cystitis > Malakoplakia
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