Malakoplakia mimicking carcinoma metastatic to lung

Malakoplakia is a rare inflammatory disorder which infrequently involves sites outside of the lower genitourinary or gastrointestinal tract. We report a case of malakoplakia in which the patient presented with a left renal mass and bilateral pulmonary nodules suggestive of metastatic renal carcinoma. Postmortem cultures of the lesions grew E. coli; macrophages at both sites contained gram-negative bacilli and numerous Michaelis-Gutmann bodies. X-ray spectroscopic analysis of the bodies showed wide variation in calcium, phosphorus, and iron content, suggesting that Michaelis-Gutmann bodies were formed in part by the deposition of amorphous salts.