Malakoplakia of the gastrointestinal tract: clinicopathologic analysis of 23 cases.
BACKGROUND
Malakoplakia is an uncommon, tumor-like inflammatory disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria. The genitourinary tract is the most common site of involvement, however, cases have also been described in the gastrointestinal tract, suggesting that it is the second most common site of involvement. This study investigates the clinical and histologic features of malakoplakia in the gastrointestinal tract.


CASE PRESENTATION
For 23 gastrointestinal specimens (biopsies and resections) from patients with a pathologic diagnosis of malakoplakia, we recorded the gender, age, location, primary diagnosis, endoscopic or surgical indication, endoscopic/gross impression and immune status (immunocompromised vs. immunocompetent).


CONCLUSION
Malakoplakia occurred throughout the length of the gastrointestinal tract with most of the cases located in the sigmoid colon and rectum (n = 10); other sites included the transverse and descending colon (n = 4), stomach/gastroesophageal junction (n = 4), appendix (n = 2), cecum (n = 1), small bowel (n = 1), and the peri-anal area (n = 1). Endoscopically, these lesions most commonly appeared as polyps (n = 10) or masses (n = 5), other clinical endoscopic impressions varied from a thickened area/fibrosis to mucosal erythema. Most patients were immunocompromised due to a disease state (e.g. organ transplantation, cancer diagnosis, autoimmune condition) and/or medication effect. Eight patients with malakoplakia were on immunosuppressive medications (8/23, 35%). Common immunosuppressed disease states included cancer (n = 9), autoimmune disease (n = 5), status post organ transplantation (n = 4), diabetes (n = 5), infection/sepsis (n = 3), and HIV/AIDS (n = 1). Some patients had multiple co-morbidities (i.e. diabetes and organ transplant). Twenty-one patients with malakoplakia were in an immunosuppressive state (21/23, 91%).
['Lee|Michael|M|', 'Ko|Huaibin Mabel|HM|', 'Rubino|Anthony|A|', 'Lee|Hwajeong|H|', 'Gill|Ryan|R|', 'Lagana|Stephen M|SM|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001706:Biopsy D002648:Child D002675:Child, Preschool D005260:Female D041981:Gastrointestinal Tract D006801:Humans D016867:Immunocompromised Host D007166:Immunosuppressive Agents D008287:Malacoplakia D008297:Male D008875:Middle Aged D012007:Rectum D055815:Young Adult
Malakoplakia Gastrointestinal tract Pathology