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Endoscopic mucosal resection of a rectal malakoplakia in a healthy adult
Author(s) -
Sato Harunobu,
Tsukamoto Tetsuya,
Mizuno Yoshihisa,
Ichikawa Tomoaki,
Kotani Yoshihito,
Honda Katsuyuki,
Hatta Kouhei,
Kuroda Makoto
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12222
Subject(s) - malakoplakia , medicine , colonoscopy , rectum , perforation , histiocyte , malacoplakia , pathology , gastroenterology , colorectal cancer , cancer , materials science , punching , metallurgy
Malakoplakia in the gastrointestinal tract is rare in healthy young people without underlying disease. Sufficient tissue is required for accurate diagnosis. We describe a malakoplakia that developed in a healthy young woman and was treated by endoscopic mucosal resection ( EMR ). A 40‐year‐old woman with a history of taking oral contraceptives until one year earlier was referred to our hospital with anal bleeding and constipation. A colonoscopy carried out at our another hospital 18 months earlier disclosed no abnormal findings. Colonoscopy at presentation revealed a yellowish‐white tumor, 5 mm in diameter, in the rectum. The lesion was slightly protruded and had a smooth flat surface, without erosion or ulceration. EMR was carried out for a definitive diagnosis. Histopathological examination showed that the tumor contained granular histiocytes, positive for CD68 and negative forcytokeratin ( AE1 / AE3 ). Several histiocytes contained intracytoplasmic round bodies ( M ichaelis– G utmann bodies), which reacted positively with periodic acid‐ S chiff and calcium ( V on K ossa) stains. Intracytoplasmic Escherichia coli (von H ansemann bodies) were identified by G iemsa staining. Based on these results, the tumor in the rectum was diagnosed as a malakoplakia. Following EMR , the patient did not receive further treatment for malakoplakia because she had no symptoms associated with malakoplakia. She has been well for more than 9 months, with no symptoms of disease. Awareness of colorectal malakoplakia is important in patients taking steroids, including oral contraceptives.