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Colonic Diffuse Large B-cell Lymphoma Hidden in Actinomycosis
Sang Hoon Lee1, Seung-Joo Nam1, Sung Joon Lee1
1Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
Summary
Actinomycosis can mimic cancer, leading to misdiagnosis. A case of colonic diffuse large B-cell lymphoma (DLBCL) was initially mistaken for actinomycosis, highlighting diagnostic challenges in gastrointestinal oncology.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Gastrointestinal cancers, particularly lymphoma, can present with complex symptoms mimicking infectious diseases.
- Accurate diagnosis is crucial for effective treatment, yet challenging due to limitations in biopsy sampling.
Observation:
- A 76-year-old woman presented with symptoms and imaging suggestive of a colon mass.
- Initial colonoscopic biopsy indicated actinomycosis, leading to antimicrobial treatment.
- Despite treatment, the patient's condition worsened, with disease progression evident on follow-up imaging.
Findings:
- A subsequent biopsy confirmed diffuse large B-cell lymphoma (DLBCL) of the colon, not actinomycosis.
- The case illustrates the potential for actinomycosis to obscure the diagnosis of lymphoma.
- Delayed diagnosis due to misinterpretation contributed to the patient's unfavorable outcome.
Implications:
- Clinicians must maintain a high index of suspicion for malignancy in cases of suspected actinomycosis, especially with treatment failure.
- Advanced imaging and repeat biopsies may be necessary for definitive diagnosis of gastrointestinal masses.
- This case underscores the importance of considering co-existing pathologies and the limitations of superficial biopsies in diagnosing complex gastrointestinal conditions.
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