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Case Reports
. 2011 Oct;27(4):545-6.
doi: 10.4103/0970-1591.91450.

Actinomycosis in urachal remnants: A rare cause of pseudotumor

V Chaitra  1 , T Rajalakshmi, Suravi Mohanty, N K Lahoti, Arun George, Jyothi Idiculla
Affiliations
Case Reports

Actinomycosis in urachal remnants: A rare cause of pseudotumor

V Chaitra et al. Indian J Urol. 2011 Oct.

Abstract

Actinomycosis is a chronic inflammatory condition caused by Actinomyces israeli, a gram positive anaerobic bacterium. It can have a variety of clinical manifestations and can mimic a malignancy. We present one such case of urachal actinomycosis that mimicked a tumor. A 28-year-old man presented with abdominal pain of 20 days duration. Per abdominal palpation revealed a firm mass with ill-defined borders in the suprapubic region. Computed tomography and magnetic resonance imaging scans of the pelvis showed an irregular lesion in the urinary bladder extending to the umbilicus, giving the impression of urachal remnants with inflammation. Peroperatively, an irregular, hard mass measuring 6 × 5 cm, involving the anterior and posterior bladder walls, the appendix, the terminal ileum and sigmoid colon, was seen, which was suspicious for a malignancy. Frozen sections from the mass showed extensive inflammation and a florid fibroblastic proliferation, giving the impression of an inflammatory pseudotumor. The tissue was extensively sampled for paraffin sections and only one of them revealed a colony of Gram, PAS and GMS- positive organisms, conclusive for Actinomycosis. It is important to be aware of this uncommon, yet significant, presentation of a common infectious disease in order to avoid misdiagnosis and over-treatment as a malignancy.

Keywords: Actinomycosis; pseudotumor; urachal remnants.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Axial T2 fat-suppressed magnetic resonance imaging shows an irregular, mixed-intensity lesion superior to the urinary bladder with adjacent fat stranding, suggesting inflammatory changes. (b) Sagittal T1 MRI shows an irregular, hypointense lesion superior to the urinary bladder, extending to the umbilicus
Figure 2
Figure 2
Section from the mass showing marked fibroblastic proliferation accompanied by a dense inflammatory cell infiltrate (H and E, ×40). Inset shows a colony of filamentous organisms surrounded by a Splendore-Hoeppli zone and neutrophils (H and E, ×400)
See this image and copyright information in PMC

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