PULMONARY MALACOPLAKIA DIAGNOSED BY FINE-NEEDLE ASPIRATION - A CASE-REPORT

BACKGROUND: Pulmonary malakoplakia is an uncommon disorder, with 24 pr eviously reported cases, only 4 of which were diagnosed by bronchial w ashings, bronchial brushings or aspiration cytology. We report a case that was diagnosed initially by computed tomography (CT)-guided fine n eedle aspiration (FNA) cytology.CASE: A 56-year-old male with follicul ar small cleaved cell lymphoma had a 10-cm left lower lobe mass compre ssing the main bronchus to that lobe. A transthoracic, CT-guided FNA s pecimen consisted predominantly of foamy macrophages, many of which co ntained typical Michaelis-Gutmann bodies. Microbiologic cultures ident ified Rhodococcus equi. A subsequent transbronchial biopsy and left pn eumonectomy specimen confirmed the cytologic diagnosis. CONCLUSION: Pu lmonary malakoplakia associated with R equi pneumonia is a rare lesion that is essentially limited to immunocompromised hosts. Awareness of the FNA cytomorphology of this lesion permits resolution of the typica l clinical differential diagnosis of pulmonary masses in the immunocom promised host and can facilitate treatment.