Extensive involvement of the urinary tract and related structures by malakoplakia presented difficult diagnostic problems in two elderly individuals. At post-mortem examination there was bilateral adrenal cortical hyperplasia in both patients and, in one, there was also a pancreatic glucagonoma and diffuse hyperplasia of the pancreatic islet tissues. There is now an increasing body of evidence that malakoplakia is associated with hypercorticosteroidism possibly due to an effect on macrophage exocytotic mechanisms. The coexistence of malakoplakia and glucagonoma has not been previously described.
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