Malacoplaquia testicular: aportación de un nuevo caso y revisión de la literatura científica

Malakoplakia is a uncommon chronic granulomatous condition of a benign nature preferentially occurring in the genitourinary tract. Testes are affected in 12% of cases, and the first case of testicular malakoplakia was reported in 1958. Forty cases have been reported worldwide since that date. We report a new case of testicular and epididymal malakoplakia in a 68-year-old male patient diagnosed of complicated orchiepididymitis who underwent orchidectomy to rule out a malignant tumor. The histopathological study demonstrated a chronic inflammatory infiltrate with histiocytes with an eosinophilic cytoplasm containing the characteristic Michaelis-Gutmann bodies diagnostic of malakoplakia.In connection with this new case and because of its unusual presentation, the literature on testicular malakoplakia is reviewed.     

A case of malakoplakia of the testis and epididymis

A forty-two year-old man with left epididymo-testicular malakoplakia was reported. Thirty-two cases of testicular malakoplakia with (5 cases) and without (27 cases) epididymal malakoplakia were reviewed. The mean age was 48. 2 year-old. Two-thirds of the cases suffered from right side involvement. All cases except a few cases received orchiectomy within 2.6 months on average from the onset of the symptoms. Diabetes mellitus, malignant diseases, or chronic renal failure seem to have a causal relation to the development of testicular malakoplakia. Six cases of epididymal malakoplakia were also reviewed.     

New fine structural observations in testicular malakoplakia: Role of the sertoli cell

A case of testicular malakoplakia is described in which cells other than histiocytes were involved in the tissue response. The abundant cell junctions, some closely related to mitochondria, and the peripheral displacement of rough endoplasmic reticulum by abundant phagolysosomes, suggests involvement of Sertoli cells, in addition to histiocytes. It is suggested that, perhaps, some forms of granulomatous orchitis and malakoplakia represent a single disease process observed at a different stage in its evolution.     

Childhood hemolytic uremic syndrome is associated with adolescent-onset diabetes mellitus

Extra-renal manifestations of the hemolytic uremic syndrome in children are well described. Pancreatic involvement may manifest as transient hyperglycemia and permanent diabetes mellitus. Two previous case reports demonstrate short periods of “remission” between initial hyperglycemia and the development of permanent diabetes mellitus. We report an unusual case of a two-year-old Caucasian boy whose HUS-associated hyperglycemia resolved shortly after the acute phase of his illness only to recur as permanent diabetes mellitus at puberty. To our knowledge no other case is reported that demonstrates such a long interval between initial presentation and the development of permanent diabetes mellitus.     

Pseudotumor of the Tracheal-Laryngeal Junction with Unusual Morphologic Features Caused by Rhodococcus equi Infection

Infectious pseudotumors are unusual proliferations of histiocytes in response to certain microbial organisms. Occasionally this process may involve large airways, producing a mass lesion that may cause respiratory obstruction. Infectious pseudotumors can be confused with malignancy in their radiologic appearance and clinical presentation. We present a case of an aggressive endotracheal pseudotumor associated with Rhodococcus equi infection in a patient with advanced HIV disease. Microscopically, the lesion was composed of sheets of epithelioid histiocytes with large, strongly eosinophilic intra-cytoplasmic granules and features of malakoplakia. In this report, we review the literature of these unusual lesions and compare them to cases of conventional malakoplakia involving the large airways. We also explore the pathogenetic mechanisms that may contribute to the distinctive histologic appearance of Rhodococcus-associated pseudotumors.     

Diabetes delaying the diagnosis of RPGN

The present case describes the unusual association of a crescentic glomerulonephritis (GN), diabetes mellitus and a monoclonal gammopathy. After an unexplained deterioration of renal function, a kidney biopsy was performed. The finding of crescentic glomerulonephritis was unexpected. This case illustrates the usefulness of kidney biopsy in diabetes to exclude concomittant disease.     

Genito-urinary malacoplakia. Report of 10 cases and review of the literature

The malakoplakia is a rare and benign disease. Its urinary localisation is commonly known. It has no clinical particularity. The diagnosis is histological. The physiopathology is infectious associated with a local macrophage function failure. The treatment associates antibiotic and colinergic drugs. Surgical removal is necessary only when the organ is destroyed. We report 10 cases of urinary malakoplakia with 4 renal localisation's causing pyonephrosis in the majority of cases, 3 prostatic localisation's that were wrongly considered as prostatic adénocarcinoma after a rectal examination and finally 3 testicular localisation's causing a necrotic destruction of the testis. The urinalysis was positive in 4 cases. We did 4 kidney removals, 3 endoscopic prostatic resections and 3 testis removals. The diagnosis was made by the histological examination of the surgical products.     

Incidentally detected bilaterally symmetrical seminal and vas calcification in young infertile male: a case report, literature review and algorithm for diagnosis

Bilateral seminal and vas calcification is not common, especially in young age. Association with many disease conditions has been described, with diabetes mellitus being the most common association. A 34-year-old man presented with primary infertility and right upper ureteric calculus. His evaluation revealed extensive, bilateral seminal and vas calcification with normal semen analysis and first-time detected diabetes mellitus. His female partner was evaluated and found to have bilateral fallopian tubes blockage. We reviewed the literature and present here the algorithm for diagnosis of such patients, along with details of this particular patient.     

Renal parenchymal malakoplakia —a case report and review of the literature

Malakoplakia is an inflammatory condition associated with persisting bacterial antigen in macrophages and characterised histologically by the Michaelis-Gutmann body, containing bacterial fragments. We review the pathogenesis of malakoplakia and report a novel form of treatment successfully used in an 8-week-old infant with bilateral renal malakoplakia. The patient presented with an acuteEscherichia coli urinary tract infection and enlarged kidneys. Antibiotic regimes were ineffective, but once the diagnosis was made treatment was changed to an immunosuppressive regime of prednisolone and azathioprine, to which she responded promptly. Renal malakoplakia should be considered in any patient with a urinary tract infection unresponsive to antibiotics and enlarged kidneys. Although a large proportion of patients with malakoplakia have an underlying systemic disorder, which may account for their abnormal macrophage function, the rest demonstrate either an isolated macrophage defect or no detectable anomaly at all. It is in this latter group we suggest that an immunomodulating regime can be curative.     

Malacoplakia and renal transplantation. Report of a case of testicular malacoplakia

The authors report a case of testicular malakoplakia in a renal transplant patient. They emphasise the predisposing role of immunosuppression which was particularly intense in this patient and they stress the risk of dissemination of the disease to the graft.     

Pilot Study: Association of Traditional and Genetic Risk Factors and New-Onset Diabetes Mellitus Following Kidney Transplantation

Introduction

New-onset diabetes mellitus, which occurs after kidney transplant and type 2 diabetes mellitus (T2DM), shares common risk factors and antecedents in impaired insulin secretion and action. Several genetic polymorphisms have been shown to be associated with T2DM. We hypothesized that transplant recipients who carry risk alleles for T2DM are “tipped over” to develop diabetes mellitus in the posttransplant milieu.

Methods

We investigated the association of genetic and traditional risk factors present before transplantation and the development of new-onset diabetes mellitus after kidney transplantation (NODAT). Markers in 8 known T2DM-linked genes were genotyped using either the iPLEX assay or allelic discrimination (AD)-PCR in the study cohort testing for association with NODAT. We used univariate and multivariate logistic regression models for the association of pretransplant nongenetic and genetic variables with the development of NODAT.

Results

The study cohort included 91 kidney transplant recipients with at least 1 year posttransplant follow-up, including 22 who developed NODAT. We observed that increased age, family history of T2DM, pretransplant obesity, and triglyceridemia were associated with NODAT development. In addition, we observed positive trends, although statistically not significant, for association between T2DM-associated genes and NODAT.

Conclusions

These findings demonstrated an increased NODAT risk among patient with a positive family history for T2DM, which, in conjunction with the observed positive predictive trends of known T2DM-associated genetic polymorphisms with NODAT, was suggestive of a genetic predisposition to NODAT.     

Emphysematous prostatic abscess with rectoprostatic fistula

Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.     

Testicular microlithiasis in Taiwanese men

Testicular microlithiasis (TM) is an unusual ultrasonographic manifestation in testicular parenchyma. Limited information is available about TM in Taiwanese men. We performed a retrospective analysis to investigate the characteristics of TM and its association with testicular cancer and infertility in Taiwan. Male patients who had received scrotal ultrasonography because of scrotal symptoms or infertility between January 2000 and December 2003 were recruited. The incidence of TM was 7.6%. Both testicular microlithiasis and testicular cancer occurred chiefly in the third decade. Patients with TM exhibit a higher chance of testicular cancer (6% vs. 0.9%). No local field effect between TM and testicular cancer was observed. Testicular microlithiasis severity is not positively correlated with sperm quality and sterility. Forty-eight patients (32%) were available at follow-up. No patient developed a testicular tumor or elevated tumor markers (AFP, beta-hCG) during follow-up. We suggest monthly self-examination, annual scrotal ultrasonography and tumor markers screening between the age of 20 and 30 years of patients with TM.     

Coexistence of malakoplakia and multifocal diffuse large B cell lymphoma of colorectum

We report a case of concurrent multifocal diffuse large B cell lymphoma and malakoplakia of colorectum in a 36-year-old man presenting with recurrent bloody diarrhoea. Malakoplakia has been described in association with a variety of malignant and nonmalignant conditions. To the best of our knowledge, this is the third report of coexistence or association of malignant non-Hodgkin lymphoma and malakoplakia in the literature, and the first report ever in the colorectum.     

Diabetes mellitus presenting as "acute osteomyelitis" of the index finger

A case of previously undiagnosed maturity onset diabetes in a fifty-eight-year-old man with a "septic index finger" is reported. Initial X-rays showed gross destruction of the distal phalanx, suggestive of acute osteomyelitis. Control of the diabetes combined with minimal debridement of the finger resulted in healing of the lesion. X-rays taken four weeks later showed complete reconstitution of the distal phalanx, confirming the need to be conservative in the management of lesions associated with diabetes. In spite of a careful and extensive search into the literature covering unusual presentations of diabetes mellitus, the author is unable to trace a similar recorded case involving the digit of upper limb.     

Malakoplakia occurring in association with Colon carcinoma

Malakoplakia, characterized by histiocytes with Michaelis-Gutmann bodies, is a rare entity. It is particularly so in the gastrointestinal tract, where it has been described in association with colon cancer, with about 20 cases described worldwide. The significance of this condition lies in its potential effect upon the preoperative staging and treatment of associated colorectal cancer. Its presence may lead to preoperative clinical and radiological over staging and more extensive resection, as well as the use of neoadjuvant therapy or a decision to undertake palliative care. This condition is more common in males. We present the case of the oldest reported patient with this association. The patient was a 90-year-old female who was treated with a sigmoid resection for an obstructing sigmoid lesion. At operation, the left ureter was embedded within an inflammatory pericolic mass but was not grossly involved with tumor. The tumor was a Dukes’ stage B adenocarcinoma and occurred in association with malakoplakia.     

Nocardia epididymo-orchitis in an immunosuppressed patient

The immunocompromised patient after organ transplantation is susceptible to unusual and life-threatening infections. We report a case of epididymitis that evolved into testicular nocardiosis after cardiac transplantation. An awareness of the potential for these infections and early diagnosis may prevent extensive morbidity in the post-transplantation patient.     

胰腺癌与糖尿病关联性分析的研究进展

目的总结胰腺癌和糖尿病之间的关系。方法广泛查阅近年来有关胰腺癌与糖尿病关联性研究的相关文献并进行综述。结果胰腺癌与糖尿病有着特殊的关联。患有胰腺癌的患者可能出现新发糖尿病或现有糖尿病症状恶化的现象,胰腺癌患者中约有50%的患者在确诊出胰腺癌前已患上糖尿病,提示胰腺癌和糖尿病表现出"双重因果关系"。长期患有2型糖尿病是胰腺癌发生及发展的高风险因素之一,2型糖尿病也可能由于高胰岛素血症、脂肪因子等的作用或其他因素而增加罹患胰腺癌的风险。同时,胰腺癌也是导致糖尿病发生的原因之一,但其机制尚未知,还需要获得大量信息才可以了解长期糖尿病对胰腺癌发生及发展的影响以及胰腺癌相关糖尿病的原因机制。结论胰腺癌与糖尿病之间的明确关系尚未被证实,需进一步研究来明确二者之间的关系。     

Emphysematous prostatic abscess: diagnosis and treatment

We report an unusual case of an emphysematous prostatic abscess. Prostatic abscess is a difficult clinical diagnosis associated with lower urinary tract symptomatology and frequently diabetes mellitus. Computerized axial tomography and transrectal or transurethral ultrasonography can assist in making a specific diagnosis. Definitive treatment is complete surgical drainage, which is achieved by transurethral resection of the prostate. Wide spectrum, adjuvant antibiotic therapy should be given to assure coverage of anaerobic bacteria.     

Segmental infarction of the testis: an exceptional complication of diabetes microangiopathy

We report a case of segmental infarction of the testis in a 55-year-old man. Past medical history included 12 years of type II diabetes and hypertension. The patient presented with a 2-month history of testicular pain and was found clinically and sonographically to have a testicular tumour. The pathological examination of the partial orchiectomy specimen revealed segmental infarction of the testicle secondary to diabetes microangiopathy. We propose diabetes microangiopathy as a localization and aetiology of segmental testicular infarction. A possible testicular sparing procedure through an inguinal approach may be considered in cases of testicular masses for which the clinical and imaging findings are suggestive of focal testicular infarction.