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• W2110005478 abstract "Malacoplakia is a granulomatous disease characterized by a histiocytic infiltrate (von Hanseman cells) with calcified bodies called Michaelis–Gutmann bodies. These can be seen both intra and extracellularily. The etiology of the disease is unclear. It is thought that it arises as a result of an abnormal response to an infection involving defective lysosomes and abnormal microtubular assembly (1). The first article describing the disease was published in early 1902 (2). The disease most frequently involves the urinary tract although it has been described in many other organs including the male and female genital tract, the gastrointestinal tract, the retroperitoneum, and the skin (3). Malacoplakia of the female genital tract is a rare disorder with less than 10 cases published involving the cervix 4-8). The vagina is the most commonly involved site (7). Here, we present two cases of malacoplakia: one in the cervix uteri and the other from the vulva. The surgical specimens were fixed in formalin and routinely processed. Paraffin sections were stained with hematoxylin and eosin, periodic acid-Schiff stain for mucin, von Kossa's stain for calcium, Berliner blue for iron, and S-100 immuno stain for peripheral neurogenic structures. For transmission electron microscopy (TEM)formaldehyde-fixed tissue was transferred to 3% glutaraldehyde in 0.1 Mcacodylate buffer with 4% sucrose. The material was dehydrated in graded alcohols and embedded in Agar 100 resin. The sections were cut at 50–70 nm, double stained with 5% uranyl acetate and 0.3% lead citrate, and examined using a Philips CM12 electron microscope. Case 1. A 69-year-old woman was referred for a hysterectomy because of a relapsing total prolapse with rectocele for several years. An anterior and posterior plastic surgery had been performed 13 years earlier. Case 2. A 49-year-old woman with a bluish-colored nontender 5-mm large lesion at 7 o'clock in the introitus of the vulva was found during a routine gynecological examination undertaken because of suspicion of a hereditary ovarian carcinoma. Two months earlier she had noticed pain in the vulvar region after a spinning lesson. Case 1. The received material consisted of a totally excised uterus with part of the vagina, weighing 90 g. The uterus measured 100 × 45 × 35 mm. The vaginal part measured up to 35 mm long. Macroscopically a uterine polyp of 12 mm was found, and one leiomyoma of size 10 mm. Case 2. A 5-mm vulvar tissue was sent for histopathologic examination. Case 1. Microscopic examination showed ulceration in the cervix. Focally reactive changes with hyperplastic squamous epithelium with hyper- and parakeratos were found. The endometrium was in a proliferative phase with a benign corpus polyp. There was no atypia in the aforementioned leiomyoma. Samples from the endocervix showed a small area with a histiocytic infiltrate, which with further investigation was shown to have the characteristic changes consistent with malacoplakia (Figs. 1a and 1b). Case 1.(a)Histiocytic infiltrate (→) in the vicinity of an endocervical gland (40).(b)Electron microscopic picture showing the characteristic Michaelis-Gutmann bodies (→31 000). Case 2. Microscopic examination showed squamous epithelium with granulocytes and in the stroma histiocytes with a granular cytoplasm and a foreign body inflammatory reaction. Further research confirmed the diagnosis as malacoplakia, as in case 1. In both cases the characteristic Michaelis–Gutmann bodies stained positively in the periodic acid-Schiff and von Kossa's stain, but stained negatively for S-100 (Fig. 2a). In case 1 the iron stain was negative in spite of the presence of coarse grain particles, but the iron stain was positive in case 2. Case 2.(a)Positive van Kossas stain (brown color) for calcium (×40).(b)Electron microscopic picture showing the characteristic Michaelis-Gutmann bodies (→ 25 000). In both cases the TEM method confirmed the presence of Michaelis–Gutmann bodies both intra and extracellularily (Figs. 1b and 2b). Malacoplakia of the female genital tract often occurs with vaginal bleeding (7). As a result of this bleeding and the clinical appearance of the lesion, if that can be seen, an ulcerated inflammatory process or a malignant process is often suspected. In light of this clinical fact, it is important to remember that malacoplakia does exist. Characteristic Michaelis–Gutmann bodies stain positively for periodic acid-Schiff stain, von Kossa's stain (calcium), and iron (3, 6), although the iron stain was negative in case 1. The reason for the negative staining in case 1 could be explainedby the fact that the area in question was very small, and therefore was not represented in the tissue material stained for iron. We also stained for S-100 to rule out agranular cell tumor, but that type of tumor was not present in our cases. As malacoplakia is a rare disease no general rules of treatment are available, but long-term antibiotic therapy (e.g. quinolones) and/or surgery are usually effective (1, 3)." @default.
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• W2110005478 date "2004-02-01" @default.
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• W2110005478 title "Malacoplakia of the cervix uteri and vulva" @default.
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• W2110005478 doi "https://doi.org/10.1111/j.0001-6349.2004.077c.x" @default.
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