title: Endoscopic mucosal resection of a rectal malakoplakia in a healthy adult.
abstract: 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 (Michaelis-Gutmann bodies), which reacted positively with periodic acid-Schiff and calcium (Von Kossa) stains. Intracytoplasmic Escherichia coli (von Hansemann bodies) were identified by Giemsa 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.
authors.affiliation: Department of Surgery, Rokuwa Hospital, Inazawa, Japan; Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Harunobu
authors.initials: H
authors.lastname: Sato
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kotani
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Honda
authors.forename: Kouhei
authors.initials: K
authors.lastname: Hatta
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D003113:Colonoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008287:Malacoplakia / Q000175:diagnosis* / Q000601:surgery*; D012002:Rectal Diseases / Q000175:diagnosis* / Q000601:surgery*
keywords: Michaelis-Gutmann bodies; endoscopic mucosal resection (EMR); malakoplakia; rectal tumor; submucosal tumor