What Lies Beneath – Malakoplakia: A Rare Submucosal Lesion of the Colon

Malakoplakia is a rare multiorgan granulomatous disease that can be found within the gastrointestinal tract. Its appearance can vary including polyps, ulcerations, plaques, flat lesions, erosions or even large mass lesions. Given its varied endoscopic appearance there exists a broad differential diagnosis including malignancy or pre-malignant neoplasm. Malakoplakia within the gastrointestinal tract has been observed in coexistence with colorectal adenocarcinoma; however, no direct causal association has been identified. Given the possible malignant differentials of colonic lesions, a histologic assessment is required for the diagnosis of malakoplakia. Malakoplakia is generally considered a benign condition with no specific follow-up required in the gastrointestinal tract. We present a case of a rare submucosal finding of malakoplakia in the ascending colon discovered on colonoscopy.