Urinary tract soft spot
Introduction
Brief introduction of urinary tract soft spot Malacoplakia is a rare inflammatory disease first reported by Michaelis and Gutmann in 1902. In 1903 von Hansemann named the disease as a soft spot with the Greek malaco (soft) and placia (plaque). Stanton and Maxted (1981) reviewed 153 patients with mild plaque in the bladder, 40%, ureter, 11%, renal parenchyma, 16%, and posterior peritoneal cavity, 16%. Soft spots can also occur in other parts of the body such as the genitals, gastrointestinal tract, skin, bones, mesenteric lymph nodes, etc. Patients with urinary soft spot syndrome are often accompanied by chronic Escherichia coli bacteriuria. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: renal failure
Cause
Causes of urinary tract soft spot
(1) Causes of the disease
The etiology of this disease is complicated, often accompanied by malnutrition and other diseases. Urinary soft spot syndrome is closely related to Escherichia coli infection. Why is there a small number of patients with Escherichia coli infection who have complicated soft spot syndrome? Urinary tract soft spots are related to host immune defects. However, abnormal humoral immunity has no significant effect on the onset of soft plaque, mainly due to low cellular immune function, which reduces the function of phagocytic phagocytic bacteria. The experiment proves that cyclic nucleoside phosphate The controlled microtubular function is defective, resulting in loss of intracellular bactericidal ability. Some scholars have pointed out that some monocytes contain low levels of Cyclic-guanosine monophosphate (cGMP), thus reducing The release of -glucuronidase leads to changes in the intracellular digestion process. The Wener and Curran studies have found that a decrease in the cGMP/cAMP ratio in monocytes is more meaningful for the onset than a decrease in cGMP alone. Defects cause changes in the lysin's internal environment, causing calcification of undigested bacterial debris, and the bacteria themselves can also produce Plasma membrane or toxins to resist phagocytosis, so that the body ingest or disability.
(two) pathogenesis
The mechanism is unknown, Stanto and Maxted (1981) reported that 93 patients with urinary, diseased tissue and blood culture confirmed E. coli infection in 84 patients (89%), >40 patients with immunodeficiency syndrome , autoimmune disease, cancer or other systemic disease.
It is speculated that bacterial or bacterial fragments form a calcium phosphate crystal, ie, a Michaelis-Gutmann body. The vast majority of observations support the abnormal immune response caused by bacterial digestion in the phagosome, which is the cause of soft spot.
The histological features of PAS-positive large eosinophils are called von Hansemann cells, small basophilic extracellular and intracytoplasmic calculus bodies are called Michaelis-Gutmann bodies, and electron microscopically visible foam-like soft-spotted tissue cells are engulfed in vivo. Escherichia coli or bacterial debris, although the typical Michaelis-Gutmann body can confirm the diagnosis, but there is no such body in the early stage of the disease, Callea et al (1982) reported that the kidney and bladder softening spot lesions in the whole course of the disease The medium macrophages contain a large amount of -antitrypsin, and staining with immunohistochemistry is helpful for the early diagnosis and differential diagnosis of this disease.
Prevention
Urinary tract soft spot prevention
No special precautions.
Complication
Urinary tract plaque complications Complications, renal failure
Bilateral renal soft spot is prone to renal failure.
Symptom
Symptoms of urinary soft spot syndrome Common symptoms Fever low back pain with sputum in the kidney area Bladder stimulation
Patients with multiple constitutional weakness, decreased immune function or other chronic diseases, often have urinary tract infections, the most common urine culture is Escherichia coli, followed by Proteus, Klebsiella and mixed infection, renal soft spot syndrome It has fever, low back pain and lumbar mass. Bladder plaque can have bladder irritation and hematuria. The cystoscopy shows that the lesions are mostly distributed on both sides, which are scattered or clustered in pale yellow or grayish yellow to brown soft velvet or mild bulge. The plaque is 0.1-0.3 cm in size. The surface is generally covered by undamaged mucosa. It can also have superficial ulcers. The lesions develop further, moldy, stiff, and form a broad-based mass. The ureter can cause stenosis and cause kidney. Functional damage or even no function, renal parenchymal soft spot disease rarely spread to the peri-renal space, but can be complicated by renal vein and inferior cavity thrombosis, testicular epididymitis can occur when testicular involvement, prostate soft spot syndrome is rare, once it occurs, easy Confused with prostate cancer.
Examine
Urinary tract soft spot examination
Urine examination: urine routine examination has a small amount of red blood cells and white blood cells; urine cytology, urine sediment smear or middle urinary bacterial culture can be found pathogenic bacteria, commonly Escherichia coli; urine exfoliated cell examination can be seen typical Soft plaque tissue cells.
The imaging manifestation of renal soft spot is lack of specificity, and it is difficult to distinguish it from renal malignant tumor. It can show an enlarged kidney outline in abdominal X-ray. The venous urography shows that the renal pelvis is compressed, according to the degree of development of the kidney. Excretion function can be weakened, even no function, kidney is not developed, B-mode ultrasound examination shows enlarged kidney, unclear boundary of cortex and medulla, multi-focal echogenic area in renal area, occasional diffuse hypoechoic area, difficult to abscess Identification, renal CT examination usually shows uneven density of the mass, often accompanied by necrosis, CT enhanced scan shows a low-density area of the renal lesion, renal angiography shows that the renal artery branch is under pressure abduction, sometimes visible neovascular, renal pelvis Urine angiography of the ureter and bladder soft spot showed filling defects. Cystoscopy of bladder soft spot was characterized by changes in bladder mass and inflammation.
Diagnosis
Diagnosis and diagnosis of urinary tract soft spot
In addition to urinary tract infections in the medical history, typical Michaelis-Gutmann corpuscle tissue cells were found mainly by microscopic examination.
Identification of urinary tract soft spots and urinary tract infections and tumors, mainly based on urine or in living tissue to find typical urinary tract soft tissue cells.
