Malacoplakia of the urinary system is the commonest manifestation of malakoplakia. The latter, meaning soft plaque,is a rare chronic granulomatous condition that can affect any organ.
Malacoplakia has a peak incidence in middle age, and has a female-to-male ratio of 4:1 1. The disease is more common in patients who are immunocompromised or those with diabetes mellitus.
Presenting symptoms include gross hematuria and signs of urinary tract infection, with Escherichia coli infection being very commonly found to coexist.
Although infection with E. Coli is very commonly observed, and it is thought to play a part in the pathogenesis of malacoplakia, other factors are also suspected, particularly impaired host defenses and defective phagocytosis 1.
The histologic hallmark of the disorder is the presence of basophilic inclusions, caIled Michaelis-Gutmann bodies in large eosinophilic macrophage2.
Within the urinary tract, the bladder is the most frequently affected organ (40% of patients with malacoplakia)
Imaging characteristics of malacoplakia are varied, and most commonly observed within the bladder, although plaques can extend into the distal ureters.
There may be multiple, polypoid, vascular, solid masses or circumferential wall thickening, associated with vesicoureteral reflux and dilatation of the upper urinary tract. These masses vary in size from a few millimeters to several centimeters.
Treatment and prognosis
Although malacoplakia may be extremely aggressive, invading the perivesical space, and it can even cause bone destruction, non-surgical medical management is the mainstay of treatment, and as such biopsy for accurate diagnosis is essential.
Treatment regimens include antibiotics, ascorbic acid, and a cholinergic agonist 1.
- 1. Wong-you-cheong JJ, Woodward PJ, Manning MA et-al. From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics. 26 (6): 1847-68. doi:10.1148/rg.266065126 - Pubmed citation
- 2.Haaga JR, Boll D. CT and MRI of the whole body. Mosby. (2009) ISBN:0323053750. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Malacoplakia of the bladder||✗|
|Malacoplakia of the ureter||✗|
|Malacoplakia of the urinary tracts||✗|
|Malacoplakia of the urinary systems||✗|