多發性膀胱及輸尿管軟化斑近似尿路上皮癌之案例報告
李彥羲1、陳毓騏1、吳俊賢1、何弘霖2、林嘉祥1
義大醫療財團法人義大醫院泌尿部1
義大醫療財團法人義大醫院病理部2
Multiple bladder and ureteral malakoplakia mimicking urothelial carcinoma
Yen-Hsi Lee1, Yu-Chi Chen1, Chun-Hsien Wu1, Hong-Lin He2, Victor C. Lin1
1Department of Urology, E-Da Hospital, Kaohsiung, Taiwan;
2 Department of Pathology, E-Da Hospital, Kaohsiung, Taiwan
Abstract
A 63-year-old female presented with progressive bilateral lower limbs edema, gross hematuria for one month. Obstructive left hydronephrosis which lead to acute exacerbation on chronic kidney disease was impressed. Further MRU revealed soft tissue lesions at left renal pelvis and left ureter causing obstruction over left middle third ureter. Wall thickening of the bladder left lateral wall was also found. Endoscopic examination revealed multiple yellowish nodules at the bladder and multiple polypoid lesions in left ureteral lumen and renal pelvis. Pathological diagnosis of bladder, ureter and renal pelvis lesions were all compatible with malakoplakia which was urothelial tissue with infiltration of sheets of histiocytes bearing eosinophilic granular cytoplasm and contain basophilic Michaelis-Gutmann bodies. The urine culture yielded Enterococcus faecium and Escherichia coli. The patient received oral linezolid and third generation cephalosporin for treatment and remained afebrile and asymptomatic during follow-up. Malakoplakia of the genitourinary tract is a rare granulomatous uncommon condition which could be misidentified as a malignant lesion. Since malakoplakia is found most commonly in the genitourinary tract, care should be taken to achieve correct diagnosis by careful histological examination, and thus to avoid overtreatment.