Fungal inflammatory masses masquerading as colorectal cancer: a case report

Abstract

Background: Non malignant invasive tumors of the colon and rectum are very rare. Gastrointestinal Basidiobolomycosis can present as a mass lesion mimicking colorectal cancer.

Case presentation: A 56 year old Caucasian male was evaluated for abdominal and pelvic pain for 4 weeks complicated by acute urinary retention. Radiological evaluation showed him to have recto-sigmoid and cecal mass. Endoscopic examination and biopsies did not reveal a definite diagnosis. Computerized tomography guided biopsy of the mass showed fungal elements consistent with gastrointestinal basidiobolomycosis. He was treated with Itraconazole for 12 months with very good clinical and radiological response.

Conclusion: Basidiobolomycosis of the gastrointestinal tract should be considered during evaluation of colorectal masses with atypical presentation. It is a rare entity seen more in endemic regions of the world for basidiobolomycosis including southwestern United States.

Figure 1

Magnetic Resonance Imaging scan showing circumferential thickening of cecum and rectum pre treatment.

Figure 2

Endoscopic examination of rectosigmoid region showing congested, friable lesion.

Figure 3

Papanicolaou stain of rectal mass fine needle aspiration cytology with arrows showing broad non septated fungal organism surrounded by acute inflammation.

Figure 4

Magnetic Resonance Imaging scan showing near resolution of the circumferential thickening of cecum and rectum after 1 year of antifungal therapy.