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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 848-849
Intrauterine device associated actinomycosis mimicking sigmoid colon tumor

1 Department of Pathology, Kocaeli University Medical School, Turkey
2 Department of Pathology, State Hospital Pathology Section, Kastamonu, Turkey

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Date of Web Publication27-Oct-2010

How to cite this article:
Muezzinoglu B, Kus E. Intrauterine device associated actinomycosis mimicking sigmoid colon tumor. Indian J Pathol Microbiol 2010;53:848-9

How to cite this URL:
Muezzinoglu B, Kus E. Intrauterine device associated actinomycosis mimicking sigmoid colon tumor. Indian J Pathol Microbiol [serial online] 2010 [cited 2022 May 29];53:848-9. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/848/72083

Actinomycosis is a rare chronic or subacute infectious disease resulting in suppurative and granulomatous inflammation. The disease is caused by anaerobic or facultatively anaerobic, acid-resistant Gram-positive bacteria of Actinomyces species, a normal inhabitant of the respiratory, gastrointestinal, and female genital tracts. Presentations of actinomyces infection in these organ systems can mimic the clinical and radiologic presentation of neoplasms. [1] The incidence of the abdominal-pelvic form has increased over the past 10 years and could be the result of prolonged use of intra-uterine device (IUD). [2]

A 44-year-old woman was admitted to general surgery outpatient clinics with abdominal pain, constipation, and distension. She had a 2-month history of vague abdominal pain, loss of appetite, weight loss of about 10 kg, and fatigue. Her medical history had an IUD, in use for 11 years that was removed 3 months ago. On physical examination, she had distended, tender abdomen and a palpable tumoral mass on left lower abdomen. Ultrasonograpic imaging showed a solid and cystic pelvic mass measuring 8 cm and a solid mass within the wall of the sigmoidcolon. Colonoscopy was suggestive of inflammatory bowel disease. Histologically, biopsy had exudate and ulceration. Laboratory data revealed leukocytosis and a normal electrolyte profile. Tumor markers were negative. Surgery was planned with a preoperative diagnosis of a neoplasm either colonic or ovarian origin or infection. Hysterectomy with bilateral salpingo-ophorectomy and sigmoid colon resection was performed. Microscopic examination of the surgical specimen revealed a suppurative inflammation extending to the mucosa of the colon [Figure 1] and a fibropurulant reaction over the fibro fatty tissue of the colon and bilateral adnexa with actinomycotic sulfur granules in it [Figure 2]. Upon receiving the pathology report, she was treated with systemic intravenous penicilline for 10 days. Her postoperative course was uneventful. She was discharged on 14th postoperative day with complementary treatment using oral antibiotics for 6 months.
Figure 1: Dense inflammatory infiltration in the colonic mucosa and submucosa (H and E, ×400)

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Figure 2: Actinomyces sulfur granule with surrounding inflammation (H and E, ×400)

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When it is pathogenic, Actinomyces causes a characteristic granulomatous inflammatory reaction, followed by necrosis and extensive fibrotic reaction. Abdominal actinomycosis is a persistent infectious disease that presents with clinical features of tumoral masses, inflammatory bowel disease, and diverticulitis. [3] Bowel obstruction due to actinomycosis is very rare, and few cases have been reported. [4] Actinomycosis should be considered in differential diagnosis in a woman with a history of current or recent IUD use who presents with abdominal pain or pelvic mass. Accurate diagnosis cannot be made on clinical grounds alone; it is mostly diagnosed after the examination of surgically resected material. Surgical treatment includes the excision of all necrotic tissues, drainage of abscesses, and removal of sinuses and fistulas. Early diagnosis is important to minimize morbidity due to this disease and avoid unnecessary surgery. However, the diagnosis is often obtained postoperatively from a pathology report.

In conclusion, abdominal actinomycosis is an uncommon infectious disease that must be considered among the differential diagnosis of infiltrating intra-abdominal disorders especially in woman with history of IUD use.

   References Top

1.Yi F, Prasad S, Sharkey F, Kahlenberg M. Actinomycotic infection of the abdominal wall mimicking a malignant neoplasm. Surg Infect 2008;9:85-9  Back to cited text no. 1
2.Yeguez JF,Martinez SA, Sands LR, Hellinger MD. Pelvic actinomycosis presenting as malignant large bowel obstruction: A case report and a review of the literature. Am Surg 2000;66:85-90.  Back to cited text no. 2
3.Cirafici L, Worreth M, Froehlich F. Pelvic and abdominal actinomycosis.Case report and review ot the literature. Rev Med Suisse Romande 2002;122:535-7.   Back to cited text no. 3
4.Yeguez JF, Martinez S, Sands LR, Hellinger MD. Pelvic actinomycosis as malignant large bowel obstruction: A case report and a review of the literature. Am Surg 2000;66:85-90.  Back to cited text no. 4

Correspondence Address:
Bahar Muezzinoglu
Kurucesme Doktorlar Sit E8 Kocaeli
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.72083

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