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Case Reports
. 2011:2011:747059.
doi: 10.1155/2011/747059. Epub 2011 Aug 29.

Abdominal-pelvic actinomycosis mimicking malignant neoplasm

Teresa Pusiol  1 , Doriana Morichetti, Corrado Pedrazzani, Francesco Ricci
Affiliations
Case Reports

Abdominal-pelvic actinomycosis mimicking malignant neoplasm

Teresa Pusiol et al. Infect Dis Obstet Gynecol. 2011.

Abstract

Abdominal-pelvic actinomycosis is often mistaken for other conditions, presenting a preoperative diagnostic challenge. In a 46-year-old female, computed tomography showed an abdominal-pelvic retroperitoneal mass extending from the lower pole of the right kidney to the lower pelvis. The patient had a 3-year history of intrauterine device. The mass appeared to involve the ascending colon, cecum, distal ileum, right Fallopian tube and ovary, and ureter anteriorly and the psoas muscle posteriorly. The resection of retroperitoneal mass, distal ileum appendicectomy, right hemicolectomy, and right salpingo-oophorectomy was performed. The postoperative period was uneventful. Penicillin therapy was given for six months without any complication. The retroperitoneal mass measured 4.5 × 3.5 × 3 cm, surrounded adjacent organs and histologically showed inflammatory granulomatous tissue, agglomeration of filaments, and sulfur granules of Actinomyces, with positive reaction with periodic acid Schiff. Right tubo-ovarian abscess was present. Abdominalpelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intrauterine device.

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Figures

Figure 1
Figure 1
Computed tomography (CT) scan of the abdomen showed the mass occupying the retroperitoneal space and infiltrating the ascending colon.
Figure 2
Figure 2
Computed tomography (CT) scan showed the mass occupying the extraperitoneal space infiltrating the psoas muscle posteriorly and the pelvis anteriorly.
Figure 3
Figure 3
The retroperitoneal mass consisted of chronic suppurative granolomatous inflammation, H&E 20x.
Figure 4
Figure 4
The inflammation was composed by fibroblasts, xanthomatous cells, and neutrophilic granulocytes, H&E 20x.
Figure 5
Figure 5
Colonies of Actinomyces species were detected with surrounding inflammatory infiltration, H&E 40x.
Figure 6
Figure 6
Colonies of Actinomyces species were founded in abscess areas, H&E 40x.
See this image and copyright information in PMC

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