攝護腺及膀胱軟化斑酷似膀胱癌之罕見案例報告及文獻分析

廖偉創、張德撝、陳證文、張彰琦、邱逸淳

臺北市立聯合醫院忠孝院區外科部泌尿科

臺北市立聯合醫院和平婦幼院區外科部泌尿科

Prostatic and urinary bladder malakoplakia mimic bladder cancer: rare case report and literature review

Wei-Chuang Liao¹, Te-Wei Chang², Cheng-Wen Chen², Chang-Chi Chang¹, Yi-Chun Chiu^{1, 2}

¹Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch

²Division of Urology, Department of Surgery, Taipei City Hospital, Heping Fuyou Branch

Introduction

Malakoplakia is a rare chronic inflammatory disease thought to be the result of defective bacterial phagocytosis and lysosome function, and there is difficulty in accurate diagnosis as a result of non-specific symptoms that mimic other diseases and cancers. We reported a rare case of concomitant bladder and prostatic malakoplakia in 69-year-old man presenting with intermittent painless gross hematuria.

Case presentation

A 69-year-old man presented with intermittent painless gross hematuria and mild storage symptoms for one month. Past medical history included post-traumatic hydrocephalus status post ventriculo-peritoneal shunt procedure, benign prostate enlargement with lower urinary tract symptoms, alcoholic liver disease, type II diabetes mellitus and hypertension. He denied other symptoms including fever, urinary retention or body weight loss. Transrectal ultrasound revealed enlarged prostate with intravesical growth or bladder neck mass lesion. Urine culture showed Escherichia coli urinary tract infection (UTI) for which he received culture specific antibiotics. The prostate-specific antigen value was measured at 1.11 ng/ml. No malignancy was measured in 3 samples of urine cytology test.  The cystoscopy under local anesthesia demonstrated enlarged prostate with median lobe intravesical protrusion and multiple bladder papule lesions with hypervascularity (Fig 1). He underwent Multi-pulse laser resection of prostate and bladder papule lesions. After smooth urinary catheter removal, he was discharged at postoperative day 5. The histopathological findings were urinary bladder and prostatic malakoplakia (Fig 2). No subsequent gross hematuria was found during follow-up in outpatient clinic.

Discussion

Malakoplakia is a chronic inflammatory condition, affects several organs in the body, most commonly the urinary tract, including the urinary bladder, ureters, prostate, and kidneys [1]. Its clinical manifestation is often non-specific, but is typically characterized by recurrent urinary tract infections and hematuria [1]. The diagnosis mainly depends on pathology, with lesions characterized histologically by granulomatous inflammation with the calcium or iron deposits in the Michaelis-Guttman bodies, and positive CD68 stain in von Hansemann cells [2]. Management entails antibiotic treatment of UTI and surgical resection of the lesions to treat secondary complications and obtain tissue to exclude malignancy [3]. For this case presenting with multiple bladder malakoplakia lesions mimicking urothelial carcinoma, surgical resection was performed to exclude malignancy.

Conclusion

Malakoplakia has been described as a benign condition and usually has a good prognosis. The clinical manifestations and imaging findings of malakoplakia of the bladder are similar to those of bladder neoplasm. Though conservative treatment via antibiotics may be effective, it is important to recognize bladder malakoplakia from bladder tumors, as the conditions it mimics often require surgical management.