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821Vol. 10    |    No. 1    |    Winter 2013    |U R O LO G Y   J O U R N A L

Recurrent Painless Hematuria Secondary 

to Malacoplakia of the Urinary Bladder

A Case Report and Review of Literature

Rahul Gupta, Arti Mahajan, Surender Atri, Chaman Lal Gupta 

Keywords: hematuria, urinary bladder, malacoplakia, granuloma

INTRODUCTION

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mass.(2) Clinically, the presentations may vary from a solitary lesion to more often multiple bladder 
(3) We report a case of recurrent painless 

CASE REPORT

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Corresponding Author: 

Rahul Gupta, MD; MS; DNB 
(Urology)
Post graduate Department 
of Surgery, Govt. Medical 
College Jammu, Jammu 
and Kashmir, India

Tel: +91 979 622 1166
E-mail: rajaguptadr@
rediffmail.com

Received February 2011
Accepted May 2011

Postgraduate Department 
of Surgery, Govt. Medical 
College Jammu, Jammu 
and Kashmir, India 

CASE REPORT



822 |

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Cystoscopy revealed multiple bladder lesions in the form 

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cal Michaelis-Gutmann bodies (M-G bodies) on histologi-

DISCUSSION

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munosuppressive treatments.

(7)

pathogonomic for malacoplakia. These M-G bodies (inclu-
sion bodies) are clusters of phagolysosomes enclosing par-
tially digested bacteria, such as lipid A, bacterial capsule 

salts and calcium phosphatase salts. This is the result of the 
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Malacoplakia can affect any organ, but involves the genitou-

 Clinically, urinary bladder mala-

biopsy of these lesions mandatory.
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agents (bethanechol) and ascorbic acid (the former increases 
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ing intracellular bacterial digestion by macrophages) is often 
successful.  If the medical treatment fails, then the patient 

antibiotic therapy to keep the urine abacteriuric.(7)

To conclude, malacoplakia is a rare, but treatable cause of 
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Figure 1. Tan-yellow nodules on cystoscopy. Figure 2. Classical Michaelis-Gutmann bodies on histological 
evaluation.

Case Report



823Vol. 10    |    No. 1    |    Winter 2013    |U R O LO G Y   J O U R N A L

Malacoplakia of the Bladder   |  Gupta et al

REFERENCES

1. Michaelis L, Gutmann C, 1902. Einschlusse in blastentu-
moren. Z Klin Med. 1902;47:208-15.

2. Sulman A, Goldman H. Malacoplakia presenting as a large 
bladder mass. Urology. 2002;60:163.

3. Mukha RP, Kumar S, Ramani MK, Kekre NS. Isolated Mala-
coplakia of the bladder: a rare case report and review of 
literature. Int Urol Nephrol. 2010;42:349-50.

4. Abdou NI, NaPombejara C, Sagawa A, et al. Malakoplakia: 
evidence for monocyte lysosomal abnormality correctable 
by cholinergic agonist in vitro and in vivo. N Engl J Med. 
1977;297:1413-9.

5. Witherington R, Branan WJ, Jr., Wray BB, Best GK. Malaco-
plakia associated with vesicoureteral reflux and selective 
immunoglobulin A deficiency. J Urol. 1984;132:975-7.

6. Streem SB. Genitourinary malacoplakia in renal transplant 
recipients: pathogenic, prognostic and therapeutic consid-
erations. J Urol. 1984;132:10-2.

7. Stanton MJ, Maxted W. Malacoplakia: a study of the litera-
ture and current concepts of pathogenesis, diagnosis and 
treatment. J Urol. 1981;125:139-46.

8. Smith BH. Malacoplakia of the Urinary Tract: A Study of 
Twenty-Four Cases. Am J Clin Pathol. 1965;43:409-17.

9. Long JP, Jr., Althausen AF. Malacoplakia: a 25-year experi-
ence with a review of the literature. J Urol. 1989;141:1328-
31.

10. Krauel L, Garcia-Aparicio L, Perez N, et al. Urinary and 
gastrointestinal malakoplakia in a 12-year-old girl. Urology. 
2009;73:87-9.

11. Cozar Olmo JM, Carcamo P, Gaston de Iriarte E, Jimenez 
F, Martinez-Pineiro L, Martinez-Pineiro JA. Genitourinary 
malakoplakia. Br J Urol. 1993;72:6-12.

12. Darvishian F, Teichberg S, Meyersfield S, Urmacher CD. Con-
current malakoplakia and papillary urothelial carcinoma of 
the urinary bladder. Ann Clin Lab Sci. 2001;31:147-50.

dency to persist or recur.

CONFLICT OF INTEREST

None declared.