Journal of Pathology and Translational Medicine

Case Study

Silent Colonic Malakoplakia in a Living-Donor Kidney Transplant Recipient Diagnosed during Annual Medical Examination: Go Eun Bae, Nara Yoon, Ha Young Park, Sang Yun Ha, Junhun Cho, Yunkyung Lee, Kyoung-Mee Kim, Cheol Keun Park; Korean J Pathol. 2013;47(2):163-166. Published online April 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.2.163

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Malakoplakia is a characteristic inflammatory condition, which is usually seen in the urogenital tract, and less frequently in the gastrointestinal tract. We present a case of colonic malakoplakia in an immunocompromised patient. A 55-year-old female visited the outpatient clinic for routine cancer surveillance. Her past medical history was significant for kidney transplantation 11 years ago, and she had been taking immunosuppressants. A colonoscopy revealed several depressed flat lesions and elevated polyps, which were 0.3 to 0.4 cm in size and accompanied by whitish exudates. A biopsy revealed an infiltration of histiocytes with ample granular eosinophilic cytoplasm, with some lymphocytes and plasma cells. Many histiocytes had the characteristic morphology, described as Michaelis-Gutmann bodies: one or several round basophilic structures of approximately 1 to 10 µm in size with some being laminated, some appearing homogeneous, and others having a dense central core with a targetoid appearance. These Michaelis-Gutmann bodies were positively stained on von Kossa stain, and were diagnostic for malakoplakia.

Citations

Citations to this article as recorded by

Caecal malakoplakia: a rare mimic of malignancy
Jeffrey Li Voon Chong, Noor Ali
BMJ Case Reports.2024; 17(1): e257130. CrossRef
A Surgical Challenge Generated by Colonic Malakoplakia in Disguise as a Locally Advanced Colonic Malignancy—A Case Report
Cristina Șerban, Alexandra Toma, Dragoș Cristian Voicu, Constantin Popazu, Dorel Firescu, George Țocu, Raul Mihailov, Laura Rebegea
Medicina.2023; 59(1): 156. CrossRef
Colonic malakoplakia in a cardiac transplant recipient: A case report
Sadiya Shafijan
Indian Journal of Pathology and Microbiology.2020; 63(2): 322. CrossRef
Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients
Merel M. Tielemans, Gerben A.J. van Boekel, Teun van Gelder, Eric T. Tjwa, Luuk B. Hilbrands
Transplantation Reviews.2019; 33(2): 55. CrossRef
Malakoplakia of the colon following renal transplantation in a 73 year old woman: report of a case presenting as intestinal perforation
Andrew Mitchell, Alexandre Dugas
Diagnostic Pathology.2019;[Epub] CrossRef
Colonic malakoplakia in a liver transplant recipient: A case report
Rana Ajabnoor, Mohammad Mawardi, Abdulmonem Almutawa
Human Pathology: Case Reports.2019; 18: 200323. CrossRef
Malakoplakia after kidney transplantation: Case report and literature review
John Fredy Nieto‐Ríos, Isabel Ramírez, Mónica Zuluaga‐Quintero, Lina María Serna‐Higuita, Federico Gaviria‐Gil, Alejandro Velez‐Hoyos
Transplant Infectious Disease.2017;[Epub] CrossRef
Megalocytic Interstitial Nephritis Following Acute Pyelonephritis with Escherichia coli Bacteremia: A Case Report
Hee Jin Kwon, Kwai Han Yoo, In Young Kim, Seulkee Lee, Hye Ryoun Jang, Ghee Young Kwon
Journal of Korean Medical Science.2015; 30(1): 110. CrossRef

Original Articles

Comparison of Detecting Methods of BK Virus Infection in Patients with Renal Allograft Recipients.: Sung Hak Lee, Youn Jun Park, Chul Woo Yang, Yong Soo Kim, In Sung Moon, Chang Suk Kang, Yeong Jin Choi; Korean J Pathol. 2010;44(6):636-641.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.636

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Abstract PDF

BACKGROUND
BK virus nephropathy (BKVN) is an emerging problem as a consequence of the use of potent immunosuppressive agents. Because optimal detection methods for the diagnosis of BKVN are required clinically, we compared the results of renal allograft biopsy, urine cytology, and urine and blood viral loads.
METHODS
Four hundred sixty two case notes from 2004 to 2009 at Seoul St. Mary's Hospital were reviewed. During that period, 286 cases of urine cytology for decoy cells, 938 cases of urine BKV reverse transcription-polymerase chain reaction (RT-PCR), and 1,029 cases of blood BKV RT-PCR were performed. All diagnostic methods were performed in 85 cases.
RESULTS
A histological diagnosis of BKVN was made in 2.4% of cases (11/462). Urine cytology for decoy cells was positive in 26.2% (75/286). BKV RT-PCR revealed viruria in positivity of 22.1% (207/938) and viremia in 5.2% (54/1,029). In cases of BKVN, the sensitivities of urine and blood BKV RT-PCR were all 100% and the specificities were 69% and 94.5%, respectively. In cases with positive urine decoy cells, the sensitivities of urine and blood BKV RT-PCR were 50% and 27.7%, with specificities of 77.7% and 100%, respectively.
CONCLUSIONS
BKV screening by RT-PCR assays may be a clinically useful noninvasive test to identify renal recipients with concurrent BKVN.

Citations

Citations to this article as recorded by

Prevalence of BK Virus among Iranian Renal Transplant Recipients: A Systematic Review and Meta-Analysis
Mohsen Ebrahimi, Alireza Mohebbi, Mohammad Mostakhdem Hashemi, Mobina Ashrafi Shahmirzadi
Journal of Clinical and Basic Research.2020; 4(4): 50. CrossRef
Asymptomatic hematuria associated with urinary polyomavirus infection in immunocompetent patients
Sung Hak Lee, Sung Hoo Hong, Ji Youl Lee, Tae Kon Hwang, Kyoung Suk Kim, Hyoungnam Lee, Yeong Jin Choi
Journal of Medical Virology.2014; 86(2): 347. CrossRef

Image Analysis of Glomerular Changes in Patients with Post-transplant IgA Nephropathy.: Kye Won Kwon, Hyeon Joo Jeong; Korean J Pathol. 2001;35(3):206-211.

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Abstract PDF: BACKGROUND
IgA nephropathy after renal transplantation (post-transplant IgAN) may recapitulate the IgAN of native kidneys, however, little has been reported about the histologic characteristics. The aim of this study is to apply glomerular morphometry using an image analyser to examine the histologic characteristics of post-transplant IgAN.
METHODS
The outer margin of the glomerulus (Bowman's area, BA) and glomerular tuft area (GA) were traced manually. The measured area were automatically calculated by KS300 image analysis system (Kontron, Munchen, Germany). The mesangial area (MA) was calculated with a summing each manually traced mesangial area. The total number of glomerular (GC) and mesangial cells (MC) were counted. Eight cases of renal section obtained by nephrectomy due to renal cell carcinoma (normal control: N-CTRL) and nineteen cases of renal section obtained from post-transplantation patients without IgAN (transplantation control: Tx-CTRL) served as controls.
RESULTS
A total of 35 biopsies were finally selected for measurement. BA and GA of post-transplant IgAN were 1.6 and 1.4 times larger than the N-CTRL, respectively, and were not significantly different from Tx-CTRL. MA was 1.4 times significantly larger than that of the Tx-CTRL. As compared to that of the N-CTRL, it was 1.2 times larger, but this difference was not statistically significant. The GC and MC of post-transplant IgAN and the Tx-CTRL were significantly lower than the N-CTRL. There were no significant correlations between glomerular hypertrophy and duration after renal transplantation, mesangial changes, segmental sclerosis, or degree of renal cortical interstitial fibrosis in post-transplant IgAN.
CONCLUSIONS
Prominent glomerular hypertrophy and mesangial expansion suggest a hyperfiltration injury in post-transplant IgAN and a possible way to glomerulosclerosis.

Case Report

Posttransplant Lymphoproliferative Disorder: A Report of 4 Cases.: Sunhee Chang, Jooryung Hugh, Kyung Mo Kim, Duck Jong Han, Seung Kyu Lee, Eunsil Yu; Korean J Pathol. 2002;36(1):45-50.

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Abstract PDF: Posttransplant lymphoproliferative disorder (PTLD) is a proliferation of B-cells associated with Epstein-Barr virus (EBV) infection as a complication of immunosuppression, especially by FK506. We investigated four cases of PTLD which developed either in allografts or in other organs.
Case
1 was a 38-year-old woman, who developed monomorphic PTLD in a kidney 7 years and 7 months after renal transplantation. Case 2 was a 37-year-old man, who developed monomorphic PTLD in the right submandibular lymph node 4 months after liver transplantation. Case 3 was a 60-year-old man, who developed monomorphic PTLD in the liver 8 months after liver transplantation. Case 4 was a 2-year-old female child, who developed polymorphic PTLD in the colon, liver, and mesenteric lymph node 10 months after liver transplantation. FK506 was administered to case 4. EBV was identified in the tissues of all cases by immunohistochemistry and/or in situ hybridization.

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