Malakoplakia occurring in association with colon carcinoma

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Malakoplakia is a rare inflammatory condition characterized by histiocytes containing Michaelis-Gutmann bodies.
• Its occurrence in the gastrointestinal tract, particularly with colorectal cancer, is exceptionally uncommon, with approximately 20 cases reported globally.
• The condition is more frequently observed in males.

Observation:

• This report presents a unique case of malakoplakia associated with colorectal cancer in a 90-year-old female patient, the oldest on record for this specific association.
• The patient underwent sigmoid resection for an obstructing sigmoid lesion.
• Intraoperatively, an inflammatory pericolic mass was noted, embedding the left ureter without gross tumor involvement.

Findings:

• The resected sigmoid lesion was diagnosed as Dukes' stage B adenocarcinoma.
• The adenocarcinoma was found in conjunction with malakoplakia, highlighting a rare co-occurrence.
• Histopathological examination confirmed the presence of Michaelis-Gutmann bodies within histiocytes, characteristic of malakoplakia.

Implications:

• The presence of malakoplakia can significantly impact the preoperative staging of colorectal cancer, potentially leading to overstaging.
• It may influence treatment decisions, including the extent of surgical resection, the use of neoadjuvant therapy, or palliative care considerations.
• This case underscores the importance of recognizing malakoplakia in the differential diagnosis of colorectal masses to ensure accurate patient management and avoid unnecessary interventions.