PMC5308051_01
Contrast-enhanced computed tomography scan revealing an irregular enhancing mass lesion with central hypodense area situated in hypogastric area, abutting the superior wall of bladder with thickened bladder wall
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F1
Ultrasonography followed by contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis was done, which revealed an irregular enhancing mass lesion with central hypodense area situated in hypogastric area measuring 68 mm x 64 mm x 50 mm in its maximum dimensions, with heterogeneity in the surrounding tissues probably due to extension or involvement of adjacent fat planes, abutting the dome of bladder with thickened bladder wall [Figure 1], sub-centimetric external iliac, inguinal, para-aortic, and mesenteric lymphadenopathy.
Intraoperative findings - urachal mass without bladder wall involvement and granular mucosa of urinary bladder dome on partial cystectomy
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F2
Partial cystectomy specimen revealed granular-appearing bladder mucosa with no obvious involvement by the mass [Figure 2].
Von Hansemann cells
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F3
Final histopathology report revealed that excised urachal remnant shows features of foamy histiocytes, plasma cells, giant cells with calcium deposits, and Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia [Figures 3 and 4], without any involvement of urinary bladder wall.
Michaelis-Gutmann bodies
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F4
Final histopathology report revealed that excised urachal remnant shows features of foamy histiocytes, plasma cells, giant cells with calcium deposits, and Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia [Figures 3 and 4], without any involvement of urinary bladder wall.
Immunohistochemistry revealed groups of numerous CD68-positive histiocytes and monocytes
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F5
Immunohistochemistry revealed groups of numerous CD68-positive histiocytes and monocytes [Figure 5].
Periodic acid-Schiff staining showing concomitant abundant histiocytes with Michaelis-Gutmann bodies
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F6
Periodic acid-Schiff staining also confirmed the concomitant abundant histiocytes with Michaelis-Gutmann bodies [Figure 6].