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Actinomycosis mimicking a pelvic malignancy. A case report
D R Scribner1, J Baldwin, G A Johnson
1Department of Gynecologic Oncology, University of Oklahoma Health Science Center, Oklahoma City 73190, USA. dennis-scribner@uokhsc.edu
Background:
Pelvic actinomycosis is difficult to diagnose preoperatively. The chronic infection is locally infiltrative and causes a profound induration of infected tissue planes. This induration, combined with absence of fever and leukocytosis, can mimic a pelvic malignancy.
Case:
A 55-year-old woman was diagnosed with a pelvic mass after a two-month history of intermittent lower abdominal pain. The patient had had an intrauterine device for 12 years; it was removed two months prior to an exploratory laparotomy for the symptomatic mass. The mass was highly suggestive of colorectal cancer, with the rectosigmoid colon indurated and adherent to the uterus and sacrum. The induration of the colon extended caudally to within 3 cm of the anal verge. An abdominoperineal resection was performed along with a total abdominal hysterectomy, bilateral salpingo-oophorectomy and colostomy. Pathology revealed acute and chronic endometritis, left tuboovarian abscess and extensive, acute inflammation of the rectosigmoid colon without evidence of diverticuli. Actinomycosis was diagnosed based on the characteristic sulphur granules seen on hemotoxylin and eosin staining.
Conclusion:
Actinomycosis can mimic pelvic and abdominal malignancies. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.
Insights
Pelvic actinomycosis, a rare infection, can mimic cancer, leading to unnecessary surgeries. Early diagnosis is crucial to avoid extensive procedures for this treatable condition.
Area of Science:
- Gynecologic Oncology
- Infectious Diseases
- Surgical Pathology
Background:
- Pelvic actinomycosis presents diagnostic challenges due to its infiltrative nature and lack of typical infection markers.
- The condition's presentation can closely resemble pelvic malignancies, complicating preoperative assessment.
Observation:
- A 55-year-old woman with a history of long-term intrauterine device (IUD) use presented with a symptomatic pelvic mass.
- Imaging suggested colorectal cancer, prompting extensive surgical intervention including abdominoperineal resection and hysterectomy.
- Pathology revealed actinomycosis, characterized by sulphur granules, alongside tuboovarian abscess and endometritis.
Findings:
- Actinomycosis can present as a pelvic mass, mimicking advanced cancer.
- Histopathological examination is key for diagnosing actinomycosis, identifying characteristic sulphur granules.
Implications:
- Awareness of pelvic actinomycosis is vital for surgeons to prevent misdiagnosis and overtreatment.
- Timely diagnosis can spare patients significant morbidity associated with extensive, unnecessary surgeries for presumed malignancies.