Malacoplakia or prostate cancer? Similarities and differences

Malacoplakia is a granulomatous inflammatory disorder clinically and ultrasonographically very similar to prostatic adenocarcinoma. Symptoms and physical findings are similar to prostatism and in half of the patients the differential diagnosis includes malignancy, mainly because of the presence of a hard nodule on digital rectal examination. Additionally, cases of malacoplakia can show hypoechoic nodes on transrectal ultrasound mimicking adenocarcinoma. We report a case of malacoplakia of the prostate with emphasis on its similarities and differences with prostate adenocarcinoma.

Malakoplakia after renal transplantation in the current era of immunosuppressive therapy: case report and literature review

Malakoplakia is a rare chronic granulomatous disease of unknown cause. It is thought to be caused by an acquired bactericidal defect of macrophages. Malakoplakia is associated with chronic infections and immunosuppression. Although it occurs mainly in the urinary tract, it has already been reported in almost every organ system. The isolation of bacteria, especially Escherichia coli, is common in malakoplakia patients. Here, we present a case of primary cutaneous malakoplakia in a kidney transplant recipient who had been taking prednisone, tacrolimus, and mycophenolate. Culture of a lesion grew Burkholderia cepacia complex. Treatment with high doses of trimethoprim-sulfamethoxazole was successful. We also present a systematic review of the literature, identifying 4 previously reported cases of malakoplakia after renal transplantation under similar immunosuppressive therapy, most occurring in the urinary tract or perineum and following benign courses to cure. Data in the literature suggest that malakoplakia has become even rarer since changes were made in the immunosuppressive therapy employed after kidney transplantation.