Pelvic actinomycosis presenting as a malignant pelvic mass: a case report

Abstract

IntroductionPelvic 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 presentationA 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.ConclusionsPelvic 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.

Tubo-ovarian Actinomycosis: A case report with brief review of literature

“…They are opportunistic pathogens causing infection after disruption of mucus membrane and spreads into surrounding tissue regardless of tissue planes. [1] The most frequent site of human infection is cervicofacial region, accounting for about 40 to 50% of cases. Approximately 15% cases occur in thorax.…”

“…[2,3] Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. [1] Ovarian actinomycosis is rarer because structure of an ovary is resistant to surrounding inflammatory disease. [4] It has been assumed that bacteria enter the ovary when its surface is broken by the process of ovulation.…”

“…[9] Pelvic actinomyces causes endometritis, salpingo-oophoritis, tubo-ovarian abscess, and a palpable adnexal mass mimicking a pelvic malignancy. [1] The right ovary and fallopian tube are most frequently affected with or without parametrial disease. [7] Ultimately, extension therapy may be required for severe infection before changing to an oral route.…”

“…High dose must be given for prolonged courses. [1] Penicillin is the drug of choice. In those allergic to penicillin, options include tetracycline and clindamycin.…”

Thrombocytosis and small bowel perforation: unusual presentation of abdominopelvic actinomycosis

“…H&E,x100 [8,9], tuberculosis, Crohn's disease, diverticulitis, or appendicitis, and pelvic magnetic resonance imaging (MRI) may be helpful in distinguishing between these etiologies [10]. Figure 2 shows the CT scan of the conglomerated mass composed of uterus, ovary, bowel, and abscess in the patient.…”