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Pelvic actinomycosis presenting as a malignant pelvic mass: a case report
Arife Simsek1, Asiye Perek, Ibrahim Ethem Cakcak
1Istanbul University, Cerrahpasa School of Medicine, Department of General Surgery, 34098, Fatih, Istanbul, Turkey. draksimsek@yahoo.com.tr.
Introduction:
Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively.
Case Presentation:
A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period). The cytology revealed inflammatory cells with aggregates of Actinomyces. Penicillin therapy was given for six months without any complication.
Conclusions:
Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy or dental infection. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.
Insights
Pelvic actinomycosis is a rare infection often misdiagnosed as malignancy. Early consideration in patients with pelvic masses, especially those with intra-uterine device use, is crucial for accurate diagnosis and treatment.
Area of Science:
- Gynecology
- Infectious Diseases
- Surgical Pathology
Background:
- Pelvic actinomycosis is a rare infection, accounting for 3% of all human actinomycosis cases.
- It often presents insidiously and is frequently misdiagnosed as diverticulitis, abscesses, inflammatory bowel disease, or malignant tumors, posing a significant pre-operative diagnostic challenge.
- Diagnosis is typically confirmed post-operatively.
Purpose of the Study:
- To present a case of pelvic actinomycosis initially presenting as a pelvic malignancy.
- To highlight the diagnostic challenges and emphasize the importance of considering actinomycosis in the differential diagnosis of pelvic masses.
Main Methods:
- A case report of a 48-year-old woman with a three-month history of abdominal pain, weight loss, and defecation difficulty.
- Diagnostic workup included rectosigmoidoscopy, magnetic resonance imaging, and surgical exploration.
- Cytological examination of the pelvic mass revealed Actinomyces aggregates, followed by six months of penicillin therapy.
Main Results:
- The patient presented with symptoms mimicking pelvic malignancy.
- Surgical exploration revealed a large pelvic mass adhered to the rectum and uterus, with left ureteral dilation.
- Post-operative cytology confirmed pelvic actinomycosis, which was successfully treated with penicillin.
Conclusions:
- Pelvic actinomycosis should be considered in patients presenting with pelvic masses, particularly those with a history of intra-uterine device use, appendectomy, tonsillectomy, or dental infections.
- Awareness of this condition can help surgeons avoid unnecessary extensive surgical procedures.
- Prompt diagnosis and appropriate antibiotic therapy are essential for favorable outcomes.