DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

Digital Images of interesting cases that will include the full spectrum of Dermatopathology, presented in the form of quiz.

The answer of the cases include related links and recent abstracts of articles.








Monday, September 6, 2010

Answer of Dermatopathology Case 70

Special stain: von Kossa stain




Abstract:

Perianal cutaneous malakoplakia in an immunocompetent patient. Dermatol Online J. 2010 Jan 15;16(1):10.
Malakoplakia is an uncommon inflammatory condition usually affecting the genitourinary tract, which has been associated with infections, tumors, and immunocompromised states. The condition has been reported in many different organs and it may rarely involve the skin. We describe a case of an isolated perianal cutaneous malakoplakia in an immunocompetent 23-year-old Syrian male.

[Vesico-cutaneous fistula revealing abdominal wall malakoplakia accompanied by Boeck's sarcoidosis]Orv Hetil.2010 Feb 7;151(6):220-3.
Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is hardly known, but it thought to be secondary to an acquired bactericidal defect in macrophages occurring mostly in immunosuppressed patients.
CASE REPORT: 63-year-old female patient had been treated with methylprednisolone for ten years, because of pulmonary sarcoidosis. For six month, recurrent abdominal abscess and vesico-cutaneous fistula developed. Histological examination proved malakoplakia, and Escherichia coli was detected in the abscess cavity.
METHODS: Hematoxyline eosin staining, periodic acid-Schiff, Berlin-blue and Kossa reactions were performed.
RESULTS: Microscopically malakoplakia consists of mainly macrophages, known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. In our presented case, after urological-surgical intervention and antibiotic therapy, the patient became free from complaints and symptoms.
DISCUSSION: Malakoplakia has been described in numerous anatomic locations, mainly in the urogenital tract. Malakoplakia may be complicated with fistulas in different locations: vesico-coccygeal, rectoprostatic, anorectal fistulas have been were reported in the literature, while 6 cases of malakoplakia with Boeck's sarcoidosis are published.
CONCLUSION: In the presented case sarcoidosis and the 10-year immunosuppressive treatment with methylprednisolone might have been in the background of abdominal wall malakoplakia, complicated by vesico-cutaneous fistula. The patient was successfully treated with surgery and the followed antibiotic therapy.

Cutaneous malakoplakia.Arch Pathol Lab Med. 2008 Jan;132(1):113-7.
Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is poorly understood, but it is thought to be secondary to an acquired bacteriocidal defect in macrophages occurring mostly in immunosuppressed patients or in the setting of autoimmune disease. Malakoplakia has been described in numerous anatomic locations, most commonly in the genitourinary tract. Microscopically, malakoplakia consists predominantly of sheets of macrophages known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. Cutaneous malakoplakia is a rare entity with less than 50 cases reported in the literature. In this article, we review cutaneous malakoplakia including the clinical, gross, and microscopic features as well as the treatment and prognosis of 40 cases of cutaneous malakoplakia identified in the literature.

Cutaneous malakoplakia in an HIV-positive patient.Int J STD AIDS.2007 Jun;18(6):435-6.
Malakoplakia is an uncommon granulomatous infectious disease that is found primarily in the genitourinary tract, but may rarely involve the skin. We report a case of cutaneous malakoplakia in an HIV-positive patient diagnosed on the basis of Michaelis-Gutman bodies. The patient presented with ulcers, draining sinuses and tender papules and nodules mainly on perigenital area, buttocks and right thigh.

Cutaneous malakoplakia: a report of two cases with the use of anti-BCG for the detection for micro-organisms. J Am Acad Dermatol.2000 Aug;43(2 Pt 2):351-4.
Malakoplakia is an uncommon granulomatous infectious disease that is found primarily in the genito-urinary tract, but may rarely involve the skin. Histologic findings are marked by the presence of foamy macrophages containing basophilic concentric spherules, the Michaelis-Gutman bodies. Micro-organisms are not readily identifiable. Immunostaining with polyclonal anti-mycobacterium bovis (BCG) has been described as a method of identifying bacterial and fungal organisms in situations where organisms may be sparse. We report 2 cases of cutaneous malakoplakia with demonstration of organisms by immunostaining with anti-BCG antibodies.