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Chang and Park: A rare colonoscopic finding in a renal transplant recipient

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A 50-year-old male visited Severance Hospital for colonoscopy screening without any specific symptoms. He received an allogeneic renal transplantation 20 years prior and had no associated complications. He had undergone a colonoscopy three years previously, and there were no abnormal findings. Physical examination revealed no remarkable findings. Blood test results were within normal ranges. Colonoscopy revealed multiple whitish, flat, or slightly elevated mucosal lesions measuring 10 to 20 mm in diameter in the ascending colon. The pit pattern of these lesions was not compatible with that of typical adenomas, and forceps biopsies were preformed at each portion (Fig. 1). Histological findings and immunostaining results for CD68 (PG-M1), are shown in Figure 2. What is the most likely diagnosis?
 

NOTES

Conflicts of Interest
Ji Young Chang is currently serving in the KSGE Publication Committee member in Clinical Endoscopy; however, she was not involved in the peer reviewer selection, evaluation, or decision process of this article. Soo Jung Park has no potential conflicts of interest.
Funding
None.
Acknowledgments
We would like to thank the staff involved in endoscopic retrograde cholangiopancreatography at the participating institutions.
Author Contributions
Conceptualization: SJP; Writing–original draft: JYC; Writing–review & editing: all authors.

Fig. 1.
Colonoscopy with the use of (A, B) white light and (C, D) narrow-band imaging revealed multiple whitish flat or slightly elevated mucosal lesions measured 10 to 20 mm in diameter at the ascending colon.
ce-2024-007f1.jpg
Fig. 2.
Histopathologic findings. (A) The lesions consisted predominantly of histiocytes with eosinophilic granular cytoplasm (von Hansemann cells) (arrow) (hematoxylin and eosin stain, ×200). (B) The lesion was positive for CD68 (PG-M1, ×400).
ce-2024-007f2.jpg
Fig. 3.
(A, B) Colonoscopy following after 6 months of antibiotics treatment shows complete resolution of all lesions.
ce-2024-007f3.jpg

REFERENCES

1. Mitchell A, Dugas A. Malakoplakia of the colon following renal transplantation in a 73 year old woman: report of a case presenting as intestinal perforation. Diagn Pathol 2019;14:22.
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2. Ajabnoor R, Mawardi M, Almutawa A. Colonic malakoplakia in a liver transplant recipient: a case report. Hum Pathol Case Rep 2019;18:200323.
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3. Hyun KH, Shin HD, Kim DH. Malakoplakia in a healthy young female patient. Korean J Intern Med 2013;28:475–480.
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4. Mousa OY, Corral JE, Nassar A, et al. Colonic mass and chronic diarrhea in a renal transplant patient: an uncommon case of malakoplakia: 1441. Am J Gastroenterol 2017;112:S783. S785.
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5. Haq K. Malakoplakia in kidney transplant recipients. Kidney News 2023;15:10.

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