Malacoplakia of the urinary tract

Radswiki et al.

Malacoplakia of the urinary tract is an uncommon chronic granulomatous inflammatory disease of the bladder wall. Malakoplakia (meaning "soft plaque") can affect any organ, but the urinary bladder is the commonest location.

Epidemiology

Malacoplakia has a peak incidence in middle age and has a female-to-male ratio of 4:1 1. The disease is common in patients who are immunocompromised or in those with diabetes mellitus. 

Clinical presentation

Presenting symptoms include gross hematuria and signs of urinary tract infection, with Escherichia coli infection being very commonly found to coexist.  

Pathology

Although infection with E. coli is very often observed, impaired host defence and defective phagocytosis are considered an important part of the pathogenesis 1.

Histology

Michaelis-Gutmann bodies are histologic hallmark which correspond to intracellular inclusions in the large histiocytes containing calcium 2.

Location

Within the urinary tract, the bladder is the most frequently affected organ (40% of patients with malacoplakia).

Radiographic features

Imaging characteristics of malacoplakia are varied, and most commonly observed within the bladder, although plaques may also occur in the ureters.

Malacoplakia may present as multiple, polypoid, vascular, solid masses or as circumferential wall thickening, associated with vesicoureteral reflux and dilatation of the upper urinary tract. These masses vary in size from a few millimetres to several centimetres. Occasionally, malacoplakia can be locally aggressive and invades surrounding structures even causing bone erosions 1.  

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.

History and etymology

The term derives from "μαλακία" (malakia: "soft") and "μαλακία" (plakia: "slab/plaque").

The terms "malaco"plakia and "malako"plakia are used interchangeably as latinisations of "μαλακία".

The term was first used by Von Hansseman, but the condition was first described by Michaelis and Gutmann in 1902 1.

Differential diagnosis

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Article Information

rID: 12754
System: Urogenital
Section: Pathology
Synonyms or Alternate Spellings:
  • Malakoplakia
  • Malacoplakia of the bladder
  • Malacoplakia of the ureter
  • Malacoplakia
  • Malacoplakia of the urinary tracts
  • Malacoplakia of the urinary systems
  • Malakoplakia of the bladder
  • Malakoplakia of the ureter
  • von Hansemann's disease
  • von Hansemann disease

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