MALAKOPLAKIA OF THE URINARY BLADDER-A CASE REPORT
Keywords:
Malakoplakia, Urinary bladder, Granulomatous inflammation, Michaelis–Gutmann bodies, Case report, Immunocompromised patientAbstract
Background: Malakoplakia is a rare, chronic granulomatous inflammatory disease that most frequently affects the urinary bladder but can also involve other organs. It predominantly occurs in middle-aged or immunocompromised individuals and is often associated with chronic infections by gram-negative bacteria such as Escherichia coli and Proteus species. The underlying pathogenesis involves defective bactericidal activity of macrophages, resulting in accumulation of partially digested bacteria and formation of Michaelis–Gutmann bodies. Owing to its nonspecific clinical manifestations and tumor-like appearance, malakoplakia is frequently misdiagnosed as malignancy, making histopathological confirmation essential for diagnosis.
Case Presentation: A 47-year-old female presented with clot retention and painless hematuria for eight days. Imaging studies revealed a polypoidal bladder lesion, and cystoscopy identified two yellowish plaques on the bladder wall. Complete transurethral resection of the lesions was performed. Histopathological evaluation showed foamy histiocytes with Michaelis–Gutmann bodies, confirming classic bladder malakoplakia.
Intervention and Outcome: The patient was managed with transurethral resection followed by prolonged antibiotic therapy targeting intracellular organisms. Postoperatively, she experienced complete resolution of hematuria, and follow-up cystoscopies over subsequent months showed no recurrence.
Conclusion: This case underscores the importance of considering malakoplakia in the differential diagnosis of bladder masses, particularly in immunocompromised patients. Early recognition and combined medical-surgical management can prevent misdiagnosis and achieve favorable outcomes.
References
1. Iwami K, Watanabe T, Osuka K, Ogawa T, Miyachi S, Fujimoto Y. Combined Exoscopic and Endoscopic Technique for Craniofacial Resection. Curr Oncol. 2021;28(5):3945-58.
2. Tariq MA, Mohiuddin A. Comment on: "Comparison of intracorporeal and extracorporeal anastomosis and resection in right colectomy: a systematic review and meta-analysis". Langenbecks Arch Surg. 2022;407(1):435-6.
3. Chen C, Qin L, Zhang R, Meng L. Comparison of Accuracy and Operation Time in Robotic, Dynamic, and Static-Assisted Endodontic Microsurgery: An In Vitro Study. J Endod. 2024;50(10):1448-54.
4. Gao F, Zhao X, Xie Q, Jiang K, Mao T, Yang M, et al. Comparison of short-term outcomes between robotic and laparoscopic liver resection: a meta-analysis of propensity score-matched studies. Int J Surg. 2024;110(2):1126-38.
5. Guerrero-Ortíz MA, Pellino G, Pascual Damieta M, Gimeno M, Alonso S, Podda M, et al. Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES. Surgery. 2025;180:109134.
6. Bogdan G. Editorial Comment on: "Primary Complete Transurethral Resection of Bladder Tumor Using Photodynamic Diagnosis for High-Risk Nonmuscle Invasive Bladder Cancer: Is a Restaging Photodynamic Transurethral Resection Really Necessary?" by Tadrist et al. J Endourol. 2021;35(7):1047-8.
7. Wang L, Liu ZQ, Liu JZ, Ma LY, Li XQ, Yao L, et al. Endoscopic submucosal dissection for lesions involving the anastomosis after upper gastrointestinal surgery. Surg Endosc. 2023;37(4):2806-16.
8. Metter K, Aepli P, Dumoulin FL, Hayee B, Grund KE, Farin G, et al. Endoscopic submucosal resection: a technique using novel devices for incision and resection of neoplastic lesions. Endoscopy. 2022;54(10):1001-6.
9. Soriano RM, Rindler RS, Helman SN, Pradilla G, Solares CA. Endoscopic transoral nasopharyngectomy. Head Neck. 2021;43(1):278-87.
10. Hoffman D, Ganjouei AA, Hernandez FR, Ifuku K, Miller P, Glencer A, et al. Graft choice in pancreatectomy with vascular resection: equivalent safety in selected patients. J Gastrointest Surg. 2024;28(11):1799-804.
11. Dogeas E, Tohme S, Geller DA. Laparoscopic liver resection: Global diffusion and learning curve. Ann Acad Med Singap. 2021;50(10):736-8.
12. Magistri P, Assirati G, Ballarin R, Di Sandro S, Di Benedetto F. Major robotic hepatectomies: technical considerations. Updates Surg. 2021;73(3):989-97.
13. Saetti R, Ronzani G, Meneghesso S, Silvestrini M. Operative technique: Tracheal resection and anastomosis in a revision surgery. Head Neck. 2023;45(10):2730-4.
14. Filho J, Marque SSB, Henriques AC, Dias AR, Waisberg J, Tustumi F. Pancreatoduodenectomy with Venous Resection or Palliative Therapy? A Meta-Analysis. J Coll Physicians Surg Pak. 2023;33(12):1426-32.
15. Gao Q, Li YC, You YN, Li ES, Liu ZL, Gao YC, et al. Prognostic analysis of lymph node resection and liver resection for T1b and T2 gallbladder cancer: a multi-center retrospective study. HPB (Oxford). 2025;27(7):971-80.
16. Lee JH, Park TH, Kim HK. Robotic thoracic surgery using the single-port robotic system: Initial experience with more than 100 cases. J Thorac Cardiovasc Surg. 2024;168(6):1513-22.e2.
17. Pesi B, Bencini L, Moraldi L, Tofani F, Batignani G, Bechi P, et al. Robotic Versus Open Liver Resection in Hepatocarcinoma: Surgical and Oncological Outcomes. Surg Laparosc Endosc Percutan Tech. 2021;31(4):468-74.
18. Tos SM, Osama M, Mantziaris G, Hajikarimloo B, Adeeb N, Kandregula S, et al. Spetzler-Martin grade I and II cerebral arteriovenous malformations: a propensity-score matched analysis of resection and stereotactic radiosurgery in adult patients. Neurosurg Rev. 2025;48(1):276.
19. Schneider M, Hackert T, Strobel O, Büchler MW. Technical advances in surgery for pancreatic cancer. Br J Surg. 2021;108(7):777-85.
20. Pirola F, Mercante G, Russo E, Giannitto C, Malvezzi L, Ferreli F, et al. Three-dimensional exoscope-assisted single-stage tracheal resection. Head Neck. 2022;44(12):2938-42.
21. Moonsamy P, Park B. Uniportal Robotic Lung Resection Techniques. Thorac Surg Clin. 2023;33(3):283-9.
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Copyright (c) 2025 Athar Mehmood, M. Waqas, Samar Shahzad, M. Shahzad Anwar (Author)
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