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Year : 2012  |  Volume : 55  |  Issue : 2  |  Page : 257-258
Cutaneous malakoplakia: Diagnosed cytologically


Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India

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Date of Web Publication3-Jul-2012
 

How to cite this article:
Srivastava R, Aggarwal S, Arora VK. Cutaneous malakoplakia: Diagnosed cytologically. Indian J Pathol Microbiol 2012;55:257-8

How to cite this URL:
Srivastava R, Aggarwal S, Arora VK. Cutaneous malakoplakia: Diagnosed cytologically. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Feb 25];55:257-8. Available from: http://www.ijpmonline.org/text.asp?2012/55/2/257/97900


A 42-year-old man presented with an asymptomatic nodule on the lower part of the right gluteal region. Examination revealed a superficial, skin colored, soft, non-itchy, painless nodule measuring 2 × 2 × 1 cm 3 . Fine Needle Aspiration (FNA) of the gluteal nodule was done. Air-dried methanol-fixed May-Grunwald-Geimsa (MGG) and wet alcohol-fixed Papanicolaou-stained smears were prepared for evaluation. The FNA smears were moderately cellular having singly scattered inflammatory cells with predominance of foamy macrophages. Numerous rounded, concentrically lamellated darkly staining calcified structures (Michaelis Gutmann bodies) were present intracellularly in the macrophages [Figure 1] as well as extracellularly. Neutrophils, plasma cells, eosinophils, few lymphocytes, and cell debris were seen in the background. A diagnosis of malakoplakia was given on FNA. The patient was kept on follow-up. The nodule was later removed and subjected to histopathology. Histopathology of the lesion showed sheets of macrophages with many intracellular and extracellular Michaelis Gutmann bodies [Figure 2] which were also positive for Periodic acid Schiff stain [Figure 2]. The diagnosis of malakoplakia was confirmed.
Figure 1: (PAP × 200): Rounded, concentrically lamellated darkly staining calcified structures (Michaelis Gutmann bodies) present intracellularly in the macrophages

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Figure 2: (H and E ×200): Numerous intracellular and extracellular Michaelis Gutmann bodies (arrows). Inset: Periodic acid Schiff stain

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   Discussion Top


Malakoplakia is a chronic inflammatory condition presenting as a plaque or nodule. Usual sites are the genitourinary tract, but may rarely involve lungs, gastrointestinal tract, skin, and other organs. [1] Pathogenesis involves insufficient killing of bacteria by macrophages. [2],[3] Malakoplakia is characterized by the presence of foamy macrophages with distinctive basophilic inclusions known as Michaelis Gutmann bodies, which are pathognomonic of malakoplakia. [1] These are 5-10 μm in diameter and found both as extracellular and intracellular inclusions. They are Gram negative, positive for Periodic Acid Schiff, von Kossa, and Perls' stain. [1],[4]

Malakoplakia is difficult to diagnose from the symptoms alone because the presentation varies according to the organ involved. [1] It can even mimic cancer and hence correct diagnosis is required for adequate management of the patient. So far only histopathological examinations have revealed definitive diagnosis. There are only few reports on cytologic diagnosis of malakoplakia. [5] This report highlights the importance of FNAC where all the characteristic findings were demonstrated in the smears. However, the lesion was later removed and was proven to be malakoplakia on histopathology. Periodic acid Schiff stain showed Michaelis Gutmann bodies staining positive.

Cytological features of malakoplakia are characteristic. The identification of intracytoplasmic basophilic inclusions in the macrophages with a background of inflammatory cells composed of macrophages, plasma cells, neutrophils, and eosinophils, is diagnostic. Awareness among cytopathologists can help making a diagnosis of malakoplakia on an aspiration smear. This can avoid the biopsy procedure and unnecessary surgery.

 
   References Top

1.Gupta K, Thakur S. Pulmonary malakoplakia: A report of two cases. Indian J Pathol Microbiol 2011;54:133-5.  Back to cited text no. 1
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2.Lewin KJ, Fair WR, Steigbigel RT, Winberg CD, Drolier MJ. Clinical and laboratory studies into the pathogenesis of malacoplakia. J Clin Pathol 1976;29:354-63.  Back to cited text no. 2
    
3.Lou TY, Teplitz C. Malakoplakia: Pathogenesis and ultrastructural morphogenesis. A problem of altered macrophage (phagolysosomal) response. Hum Pathol 1974;5:191-207.  Back to cited text no. 3
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4.Price HM, Hanrahan JB, Florida RG. Morphogenesis of calcium laden cytoplasmic bodies in malakoplakia of the skin. An electron microscopic study. Hum Pathol 1973;4:381-94.  Back to cited text no. 4
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5.Pérez-Barrios A, Rodriguez-Peralto JL, Martinez-Gonzalez MA, de Agustin De Agustin P, Lozano F. Malacoplakia of the pelvis. Report of a case with cytologic and ultrastructural findings obtained by fine needle aspiration. Acta Cytol 1992;36:377-80.  Back to cited text no. 5
    

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Correspondence Address:
Vinod K Arora
Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.97900

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    Figures

  [Figure 1], [Figure 2]

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[Pubmed] | [DOI]



 

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