From Big Medical Encyclopedia

MALAKOPLAKIA (malacoplakia; grech, malakos soft + plax a plate) — seldom found disease with preferential damage of a mucous membrane of a bladder. Also ekstravezikalny forms M. (defeat of ureters, renal pelvis and cups, a prostate, testicles and their appendages, intestines, skin) are described. Ganzemannom was for the first time reported about M. in 1903 (D. River of Hansemann). The disease consists in emergence of flat plaques of yellow color, various size and a configuration. Plaques can lie separately or merge with each other, sometimes ulcerate. Similar educations are located on mucous membranes more often. Much less often they meet in intersticial tissue of kidneys, testicles, a prostate. Women get sick twice more often than men.

Etiology it is not known. M.'s emergence is usually preceded hron, by inflammatory changes of uric and generative organs and therefore some authors consider that the plaques consisting of large cells like macrophages appear as a result of infiltration of a mucous membrane the infected urine. At sick M.' most find various microorganisms in plaques, is more often colibacillus. Konnak and Hart (J. W. Konnak, W. R. Hart, 1976) believe that in M.'s genesis change of phagocytosis and usual inflammatory reaction to a bacterial infection is of great importance that can take place, e.g., at use of steroid drugs for the patients suffering hron, cystitis, prostatitis, pyelonephritis. For M. existence of special large educations — Mikhaelis's little bodies — Gutmanna which are located as inside, and out of histiocytes is pathognomonic, have spherical shape and a small kernel. Cytoplasm of little bodies contains various inclusions: leukocytes, erythrocytes, bacteria and layered educations with adjournment of lime. Researches of ultrastructure of little bodies showed that they contain lamellar formations of a various crystal structure, and is histochemical established that polisakharidny and fatty components of little bodies are derivatives of the broken-up bacterial cells.

At M. of a bladder patients complain on speeded up and an urodynia, availability of blood in urine, pain in the bottom of a stomach. At damage of kidneys the wedge, a picture of a disease is shown by temperature increase, pain in a waist, a hamaturia, more rare a renal failure, anemia and arterial hypertension.

Diagnosis diseases it is difficult. At tsistoskopiya (see) on a mucous membrane of a bladder find flat small knots of yellow color with a zone of a hyperemia around. The differential diagnosis should be carried out with a tumor and tuberculosis bladder (see), chronic cystitis (see).

For specification of the diagnosis carry out a biopsy of plaques by means of an operating cystoscope.

Treatment antiinflammatory. At hemilesion of kidneys sometimes it is necessary to carry out nephrectomy (see).

At M. of a bladder and hemilesion of kidneys the forecast favorable. At bilateral damage of kidneys can develop renal failure (see).

Bibliography: The guide to clinical urology, under the editorship of A. Ya. Pytel, page 47, M., 1970; Sarnetskaya S.A. Malakoplakia of a bladder, Urology, No. 1, page 55, 1964; Cederquist L. L. Mala-coplakia of the urinary tract, Arch. Path., v. 80, p. 495,1965; D eri d d er P.A.a.o. Renal malacoplakia, J. Urol. (Baltimore), v. 117, p. 428, 1977; Hansemann W. tiber Malakoplakie der Harnblase, Virchows Arch. path. Anat., Bd 173, S. 302, 1903; K o n n a k J. W. a. H a r t W. R. Malacoplakia of the prostate in an immunosuppres-sed patient, J. Urol. (Baltimore), v. 116, p. 830, 1976; V.N.'s Smith Malacoplakia of the urinary tract, Amer. J. clin. Path., v. 43, p. 409, 1965.

B. H. Tkachuk.