個案報告: 膀胱罕見良性病灶之膀胱軟化班
林才揚1、廖建華1、沈坤宏1
1奇美醫學中心 外科部 泌尿科
Case report: Mlakoplakia - a rare benign disease of urinary bladder
Chye-Yang Lim1, Alex Chien-Hwa Liao1, Kun-Hung Shen1
1Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
Case description:
This is a 74 years old female with the history of diabetes mellitus, hypertension and end stage renal disease under hemodialysis for 2 to 3 years. Tracing back to her history, recurrent urinary tract infection (urine culture: E.coli )noted before hemodialysis, so abdominal echo arranged which revealed a 1.2cm polypoid lesion at left lateral wall of UB. Then she referred to urologist for cystoscopy. Multiple nodular lesions found and biopsy showed chronic inflammation. However, gross hematuria noted after 11 months. Thus cystoscopic examination done and nodular lesions persisted without bleeding. Re-biopsy disclosed malakoplakia. After that, close follow up suggested as it was benign lesion. After 1 year later, she re-experienced gross hematuria. Similar as previous, cystoscopy scheduled and easily bleeding nodular lesions found. After discussed with patient, she decided to undergo transurethral hemostasis and resection of tumor. Meanwhile abdominal computed tomography and bone scan done for tumor survey but all in negative findings. The final pathology compatible with previous biopsy result as malakoplakia. Under microscopic examination, immunohistochemical identified Michaelis-Gutmann bodies but no cancer cells highlighted by CK7 and CK20 immunostain. There was uneventful postoperatively.
Discussion:
Malakoplakia is a rare benign disease. It is predominant in female with older age. Bladder is the most common site of occurrence in genitourinary tract. So far, the pathogenesis of malakoplakia is uncertain but there are several hypotheses suggested. It included certain microorganism involvement such as E.coli and immunocompromised patient. There are variable clinical presentations. It could be asymptomatic, recurrence urinary tract infection, painless gross hematuria even acute renal failure. The initial treatment is antibiotic. However the outcome not promising, some patient would be self-limiting but some probably recurrence or progression. Some case reports documented combination of antibiotic with transurethral resection of bladder tumor in treating malakoplakia.
Conclusions:
Urinary bladder malakoplakia is a rare benign treatable disease. Treatment with antibiotic is the initial option. In the status of symptomatic or progression, TUR-BT could be in consideration.