may be play an important role for the pathogenesis of testicular malacoplakia. Key words: testis, malacoplakia, Michaelis-Gutmann body, E. coli, Immun

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1 An immunohistochemical and ultrastructural observation in two cases of testicular malacoplakia-its relationship to granulomatous orchitis- Takaaki Nagasawa1), Tokuhiro Ishihara1), Tadaaki Yokota1), Fumiya Uchino1), Mutsuo Takahashi2), Hiroshi Takihara3), Keiji Joko3) and Jisaburo Sakatoku3) 1) The First Department of Pathology, Yamaguchi University School of Medicine 2) Department of Clinical Laboratories, Yamaguchi University School of Medicine 3) Department of Urology, Yamaguchi University School of Medicine We report histochemical and immunohistochemical studies of two cases of testicular malacoplakia from 54-year-old (case 1) and 45-year-old (case 2) men and an ultrastructural study of case 1 with review of the literature. The testes were enlarged and the cut surface showed a neoplasma-like appearance. The testicular architecture was destroyed due to replacing by granulomatous lesion consisting predominantly of macrophages with abundant eosinophilic granular cytoplasm (so-called von Hansemann cell) in both cases. In the cytoplasm of von Hansemann cells, PASpositive inclusion bodies were frequently observed. There was no histochemical evidence of iron or calcium deposition in the inclusion bodies. Immunohistochemically, positive materials for anti-ƒ 1-antitrypsin, anti-ƒ 1-antichymotrypsin and anti- Escherichia coli (E. coli) antibodies were seen in the cytoplasm of von Hansemann cells in granulomatous lesion. Thus, we considered the inclusion body as Michaelis- Gutmann (M-G) body. Electron microscopically, various kinds of phagosomes, including M-G structures which do not seem to contain calcium, were observed in the cytoplasm of von Hansemann cells in case 1. Although, the pathogenesis of testicular malacoplakia is still unclear, bacterial infection, especially E. coli infection,

2 may be play an important role for the pathogenesis of testicular malacoplakia. Key words: testis, malacoplakia, Michaelis-Gutmann body, E. coli, Immunohistochemistry

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9 1) Stanton MJ, Maxted W: Malacoplakia: A study of the literature and current concepts of pathogenesis, diagnosis and treatment. J Urol 125: , ) McClure J: Malakoplakia. J Pathol 140: , ) Haukohl RS, Chinchinian H: Malakoplakia of the testicle. Report of a case. Am J Clin Pathol 29: , ) Blackwell JB, Finlay-Jones LR: Malakoplakia of the testis. J Pathol Bact 78: , ) Brown RC, Smith BH: Malakoplakia of the testis. Am J Clin Pathol 47: , ) Waisman J, Rampton JB: Malakoplakia of the testis and epididymis. Arch Pathol 86: , ) Yang YH, Marathe RI: Malakoplakia of the testis and epididymis (Macrophagic-Inclusion Epididymo-orchitis). Urol Int 24: , ) Shaba JK, Black WA: Malakoplakic granuloma of the testis. J Urol 105: , ) Tamura H, Iannotti HM: Ultrastructure of Michaelis-Gutmann body. A study of a case of testicular malacoplakia. Arch Pathol 98: , ) Dionne GP, Bovill EG, Seemayer TA: New fine structural observation in testicular malakoplakia. Role of the Sertoli cell. Urology 5: , ) Bradley GE: Malakoplakia of the testis. NZ Med J 83: 77-79, ) Rinaudo P, Damjanov I, Stoesser B: Malacoplakia of testis. Int Urol Nephrol 9: , ) Diaz Gonzales R, Leiva O, Navas Palacios JJ, Usera G, Gonzalez Castillo P, Montalban MA, Borobia V: Testicular malacoplakia. J Urol 127: , ) Paquin F, Schick E, Parent C: Malakoplakia of testis. Urology 21: , ) Kleinman SZ, Robinson ND, Simon SA: Malakoplakia of testis. Urology 22: , ) Saraf P, disant' Agnese P, Valvo J, Caldamone A, Linke C: An unusual case of malacoplakia involving the testis and prostate. J Urol 129: , ) Mathur RP: Malakoplakia of testis. Br J Urol 61: 262, ) McClure J: Malakoplakia of the testis and its relationship to granulomatous orchitis. J Clin Pathol 33: , ) Michaelis L, Gutmann C: Uber Einschlusse in Blasentumoren. Ztschr klin Med 47: , ) von Hansemann D: Uber Malakoplakie der Harnblase. Virchows Arch Pathol Anat 173: , 1903

10 43: , ) Callea F, van Damme B, Desmet UJ: Alpha-lantitrypsin in malakoplakia. Virchows Arch Pathol Anat 395: 1-9, ) Smith BH: Malakoplakia of the urinary tract. A study of twenty-four cases. Am J Clin Pathol

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