Malacoplaquia de cubiertas escrotales: a propósito de un caso y revisión de la literatura <span class="so-article-trans-title" dir="auto"> Translated title: Scrotal sheath malacoplakia: a case report and literature review </span>

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Abstract

Resumen: Presentamos un caso de un varón de 49 años que tras orquiectomía ante masa escrotal a estudio es diagnosticado de malacoplaquia de las cubiertas escrotales con testículo íntegro. En el estudio histopatológico se objetivaron los patognomónicos cuerpos de Michaelis-Gutmann afectando a las cubiertas, tejidos blandos fiabroadiposos y dermis profunda. La malacoplaquia es una patología inflamatoria crónica benigna poco frecuente que afecta al sistema genitourinario en más del 60% de los casos descritos por tanto es importante para el urólogo conocerla. A propósito de este caso, y dado que es el primero descrito en la literatura en el que se presenta la malacoplaquia como afectación de las cubiertas testiculares respetando el testículo, realizamos una revisión de la literatura publicada sobre esta patología.

Translated abstract

Abstract: We report the case of a 49-years-old man, who after orchiectomy is diagnosed of malakoplakia of the scrotal covers with intact testicle. The histopathology exam shows the pathognomonic Michaelis-Gutmann bodies involving scrotal covers, fibroadipose soft tissues and deep dermis. Malakoplakia is an unusual benign chronic inflammatory disease. Predominantly affects the genitourinary system in more than 60% of cases, therefore it is important for urologist to know it. In relation to a clinical case, and since this is the first case of scrotal malakoplakia with intact testicle, we perform a review of the published literature on this pathology.

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Most cited references 10

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Clinical and laboratory studies into the pathogenesis of malacoplakia.

K Lewin, W Fair, R T Steigbigel … (1976)

Three cases of malacoplakia are described. Electron microscopic studies revealed intact bacteria or bacteria in varying states of degradation within phagolysosomes of the malacoplakic macrophages. Michaelis-Gutmann bodies arise within the phagolysosomes. These findings suggest that the bacteria incorporated within the phagolysosomes persist as dense amorphous aggregates which later become encrusted with calcium phosphate crystals to form the laminated Michaelis-Gutmann bodies. Possible explanations for the unusual macrophage response in malacoplakia are: (1) infection with an unusual strain of bacteria, (2) an immunological abnormality affecting intracellular killing of organisms, and (3) an abnormality affecting intracellular digestion of organisms. In considering each of the possibilities, we have been unable to detect any unusual strain of infecting organisms in association with malacoplakia, and in vitro studies have revealed normal T lymphocyte response to mitogen and normal monocyte bactericidal capacity. According to the history, each patient had reason to have a compromised immune status; in only one, however, was this demonstrated.