Liver and intrahepatic bile ducts-nontumor

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Liver and intrahepatic bile ducts-nontumor

Infectious (non-viral) disorders

Malakoplakia

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 12 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Rare in liver; more common in bladder, but described in numerous locations
● Usually associated with Klebsiella and Escherichia coli infection, but also other bacteria, often in association with underlying systemic disease
● Three phases:
● (1) histiocytes (also called Von Hanseman histiocytes after co-discoverer) and plasma cells early
● (2) Granulomatous phase with numerous Michaelis-Gutmann calcospherites
● (3) late fibroblasts and collagen with histiocytes and only rare Michaelis-Gutmann bodies
● Apparently due to defective macrophages that phagocytose bacteria but cannot digest them, causing enlarged phagolysosomes which accumulate crystals, leading to laminated Michaelis-Gutmann inclusions

Case reports
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● 19 year old man with small bowel ileus after Klebsiella pneumonia sepsis (Arch Pathol Lab Med 2002;126:372)

Micro description
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● Aggregates of histiocytes containing small, round to oval, targetoid structures (Michaelis-Gutmann bodies)

Micro images
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H&E and stains, EM

Positive stains
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● PAS+ diastase resistant; also calcium, colloidal iron, CD68 (Michaelis-Gutmann bodies are within histiocytes)

Additional references
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● J Clin Gastroenterol 1994;19:318

End of Liver and intrahepatic bile ducts-nontumor > Infectious (non-viral) disorders > Malakoplakia

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