J Korean Soc Radiol.  2015 Jul;73(1):62-65. 10.3348/jksr.2015.73.1.62.

Renal Malakoplakia with Wide Extension into the Retroperitoneum: A Case Report

• Choi SY
• Sung DJ
• Han NY
• Park BJ
• Kim MJ
• Sim KC
• Cho SB
• Lee YJ

• KMID: 1823926
• DOI: http://doi.org/10.3348/jksr.2015.73.1.62

Abstract

Malakoplakia is a rare chronic inflammatory condition that results from defective phagolysosomal activity. Malakoplakia usually affects the urinary tract, and immunosuppression is a predisposing factor in most patients. A 78-year-old woman undergoing long-term steroid treatment presented with right flank pain. CT demonstrated a large, multilocular cystic mass with focal enhancing solid portion in the right kidney and retroperitoneum. The patient underwent ultrasonography-guided biopsy for enhancing the solid portion, and pathologic examination revealed malakoplakia.

MeSH Terms

Aged
Anti-Bacterial Agents
Biopsy
Causality
Female
Flank Pain
Humans
Immunosuppression
Kidney
Malacoplakia*
Retroperitoneal Space
Urinary Tract
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Renal malakoplakia with wide retroperitoneal extension in a 78-year-old woman. Axial (A) and coronal (B) contrast enhanced CT scan shows a large multilocular cystic mass with irregular wall and septa (arrowheads) in right kidney and perirenal space. The mass extends into the right retroperitoneum, bare area and right psoas muscle. Focal enhancing solid portion is demonstrated in the right kidney (arrow). On follow-up CT scan (C) obtained after 4 months with antibiotic treatment, the complicated cystic lesion is markedly reduced. And the enhancing solid portion is also decreased in size (curved arrow).

• 

  Fig. 2 Photomicrographs of malakoplakia. A. There are many scattered histiocytes (von Hansemann cells) containing intracytoplasmic lamellated basophilic inclusions, called Michaelis-Gutmann bodies (black arrows) (× 1000). B. A von Kossa stain highlights numerous Michaelis-Gutmann bodies (× 200).

Reference

1. Wielenberg AJ, Demos TC, Rangachari B, Turk T. Malacoplakia presenting as a solitary renal mass. AJR Am J Roentgenol. 2004; 183:1703–1705.

2. Radin DR, Siskind B, Weiner S, Bernstein R, Ziprkowski M. Retroperitoneal malacoplakia. Urol Radiol. 1984; 6:218–220.

3. Zimina OG, Rezun S, Armao D, Braga L, Semelka RC. Renal malacoplakia: demonstration by MR imaging. Magn Reson Imaging. 2002; 20:611–614.

4. Kajbafzadeh A, Baharnoori M. Renal malakoplakia simulating neoplasm in a child: successful medical management. Urol J. 2004; 1:218–220.

5. Yoon SY, Lee HJ, An JH, Kim SJ, Kim SW, Woo JH, et al. Renal parenchymal malakoplakia presenting with abscesses and hepatic extension misdiagnosed as a malignant tumor: a case report. Korean J Med. 2012; 82:764–768.

6. Cury J, Coelho RF, Franco M, Srougi M. Renal parenchymal malacoplakia with pleural effusion. Clinics (Sao Paulo). 2007; 62:87–88.

7. Dharmadhikari R, Crisp A. Sequential changes in sonographic appearances of childhood renal malakoplakia progressing to end-stage renal failure. J Ultrasound Med. 2006; 25:1219–1222.

8. Kamishima T, Ito K, Awaya H, Mitchell DG. MR imaging of bilateral renal malacoplakia after liver transplantation. AJR Am J Roentgenol. 2000; 175:919–920.