軟化斑及黃色肉芽腫性腎盂腎炎的手術預後
潘 岳1、李良明1、溫玉清1、蕭志豪1
台北市立萬芳醫院 外科部 泌尿科1
Well surgical outcome of
malakoplakia and xanthogranulomatous
which presented in the same kidney
A case report and literature review
Pan Yueh1, Liang-Ming Lee1, Yu-Ching Wen1, Chi-Hao Hsiao1
Division of Urology, Department of Surgery,
Wan Fang Medical Center, Taipei Medical University1,
Taipei, Taiwan
Malakoplakia is rare and which occurred commonly in the urinary tract. It is a tumor-like xanthogranulomatous disease which can be asymptomatic or renal mass-like lesion, chronic cystitis, pyelonephritis and complicated with obstructive uropathy. Under endoscopic view, malakoplakia commonly presents with yellow to gray polyp-like lesions. Michaelis Gutmann bodies and positive von Kossa staining are characteristics. E. coli, Proteus, Mycobacterium tuberculosis, and Staphylococcus aureus are most common organism. The treatment of malakoplakia can be antibiotics therapy and/or surgical resection. If it is a susceptible pathogen, the antibiotics trimethoprim/sulphamethoxazole, rifampicin, and ciprofloxacin are the drugs of choice for biofilm-related organisms because these drugs have good penetration into macrophages. For a multidrug-resistant microorganism such as ESBL-producing E. coli, carbapenems antibiotics plus surgical resection may be an alternative therapy.
Xanthogranulomatous pyelonephritis are also chronic infective condition of the kidney. Both xanthogranulomatous pyelonephritis and malakoplakia had similar features but malakoplakia is characterized by periodic acid-schiff positive, whereas xanthogranulomatous is characterized by periodic acid-schiff negative. Both diseases may combine but it’s rare and our case had malakoplakia and xanthogranulomatous pyelonephritis in the same kidney so that we discussed it.
This is an 82 year-old female had end-stage renal disease under hemodialysis and suffered from repeating urosepsis. Enlarged right kidney with low density within right ureter was noted on CT scan, ureteroscopy with biopsy was performed and pathology revealed xanthogranulomatous inflammation of ureter. So that she received right radical nephrectomy. Pathology report later revealed a picture of malakoplakia with marked foamy macrophage, lymphoplasmacystic cell and neutrophil infiltrate in the kidney, ureter, and perirenal fat.