Malakoplakia of the vagina diagnosed by fine‐needle aspiration cytology

Abstract

Malakoplakia is an uncommon chronic granulomatous process that most commonly affects the urinary tract, but it may rarely recur in the female genital tract. It appears to result from a defect in macrophage function resulting in an inability to destroy ingested bacteria. We describe the fine needle aspiration cytology of malakoplakia in a 84-yr-old woman presenting with a large pelvic mass involving the apex of the vagina. The patient's history was significant for cervical squamous cell carcinoma in the remote past. CT-guided needle aspiration yielded cellular smears with large numbers of isolated histiocytes, as well as polymorphonuclear leukocytes, lymphocytes, and plasma cells. The histiocytes had central nuclei and abundant granular cytoplasm containing target-shaped, laminated bodies (Michaelis-Gutmann bodies). These bodies were PAS positive and focally von Kossa positive. Large numbers of intracellular and extracellular bacteria were also seen on the smears. The characteristic cytologic findings obtained by needle aspiration were diagnostic of malakoplakia with a rare and unusual clinical presentation.