Pulmonary malakoplakia diagnosed by fine needle aspiration : A case report

BACKGROUND: Pulmonaqy malakoplakia is an uncommon disorder, with 24 previously reported cases, only 4 of which were diagnosed by bronch washings, bronchial brushings or aspiration cytology. We report a case that was diagnosed initially by computed tomography (CT)-guided fine needle aspiration (FNA) cytology. CASE: A 56-year-old male with follicular small cleaved cell lymphoma had a 10-cm left lower lobe mass compressing the main bronchus to that lobe. A transthoracic, CT-guided FNA specimen consisted predominantly of foamy macrophages, many of which contained typical Michaelis-Gutmann bodies. Microbiologic cultures identified Rhodococcus equi. A subsequent transbronchial biopsy and left pneumonectomy specimen confirmed the cytologic diagnosis, CONCLUSION: Pulmonary malakoplakia associated with R equi pneumonia is a rare lesion that is essentially limited to immunoconpromised hosts. Awareness of the FNA cytomorphology of this lesion permits resolution of the typical clinical differential diagnosis f pulmonary masses in the immunocompromised host and call facilitate treatment.