Pelvic actinomycosis mimicking ovarian malignancy: three cases

Objective: Three cases of pelvic actinomycosis initially diagnosed as pelvic malignancy and treated surgically are reported. Cases: The first case was a 38-year-old multiparous woman who was referred to our clinic because of bilateral ovarian solid masses. With the impression of ovarian carcinoma, a laparotomy was performed. During surgery adhesiolysis, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, appendectomy, peritoneal washings, and peritoneal abscess drainage were performed. The second patient was a 37-year-old woman who presented with a left-sided fixed solid mass highly suggestive of pelvic malignancy. Both ureters were found to be dilated with hydronephrosis in the right kidney supporting the diagnosis of retroperitoneal fibrosis. Excision of the mass, colectomy and temporary diverting colostomy and stent insertion to the left ureter were performed. Colostomy repair was performed five months later. On the fifth day postoperatively, fascial necrosis developed so a Bogotabag was placed on the anterior abdominal wall and left for secondary healing. The third patient was a 51-year-old postmenopausal woman incidentally diagnosed as having a pelvic mass while having been investigated for constipation and nausea. She had had a colostomy one year before and a reanastomosis two months after. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. In all cases, histopathologic staining of the specimens revealed chronic inflammation containing actinomy-costs abscesses confirmed with microbiologic identification. Conclusion: Pelvic actinomycosis is an uncommon cause of a pelvic mass. However, it should be kept in mind in the differential diagnosis of pelvic masses, especially in the patients with a history of IUD use to avoid an unnecessary extensive surgical procedure.

Pelvic actinomycosis; Ovarian carcinoma; Retroperitoneal fibrosis; Colon carcinoma; IUD

[1] Russo T.: “Actinomycosis”. Harrison’s Principles of Internal Medicine, 14th edn., 1998, 168, 989.

[2] Chakrabarty D., Wessely Z.: “Ovarian actinomycosis”. NY State J. Med., 1978, 78, 806.

[3] Fiorino A.S.: “Intrauterine contraceptive device-associated actinomycotic abscess and Actinomyces detection on cervical smear”. Obstet. Gynecol., 1996, 87, 142.

[4] Gupta P.K., Hollander D.H., Frost J.K.: “Actinomycetes in cervico-vaginal smears: an association with IUD usage”. Acta Cytol., 1976, 20, 295.

[5] Gupta P.K.: “Intrauterine contraceptive devices. Vaginal cytology pathologic changes and clinical implications”. Acta Cytol., 1982, 26, 571.

[6] Lippes J.: “Pelvic Actinomycosis: A review and preliminary look at prevalance”. Am. J. Obstet. Gynecol., 1999, 180, 265.

[7] Westhoff C.: “IUDs and colonization or infection with actinomyces”. Contraception, 2007, 75 (6 suppl.), 48.

[8] Scribner D.R., Baldwin J., Johnson G.A.: “Actinomycosis mimicking a pelvic malignancy: a case report”. J. Reprod. Med., 2000, 45, 515.

[9] Hoffman M.S., Roberts W.S., Solomon P.: “Advanced actinomycotic pelvic inflammatory disease simulating gynecologic malignancy: a report of two cases”. J. Reprod. Med., 1991, 36, 543.

[10] Perlow J.H., Wigton T.,Yordan E.L., Graham J., Wool N., Wilbanks G.D.: “Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device”. Rev. Infect. Dis., 1991, 13, 1115.

[11] Powell J.L., Cunill E.S. , Kotwall C.A., Turner J.F., McKinney C.D.: “Advanced pelvic actinomycosis infection mimicking malignancy”. J. Pelvic Med. Surg., 2005, 11, 269.

[12] Sehouli J., Stupin J.H., Schlieper U., Kuemmel S., Henrich W., Denkert C. et al.: “Actinomycotic inflammatory disease and misdiagnosis of ovarian cancer. A case report”. Anticancer Res., 2006, 26, 1727.

[13] Atay Y., Altintas A., Tuncer I. , Cennet A.: “Ovarian actinomycosis mimicking malignancy”. Eur. J. Gynaecol. Oncol., 2005, 26, 663.

[14] Willscher M.K., Mozden P.J., Olsson C.A.: “Retroperitoneal fibrosis with ureteral obstruction secondary to Actinomyces israeli”. Urology, 1978, 12, 569.

[15] Milam M.R., Schultenover S.J., Crispens M., Parker L.: “Retroperitoneal fibrosis secondary to actinomycosis with no intrauterine device”. Obstet. Gynecol., 2004, 104, 1134.

[16] Bercovich A., Guy M., Karayiannakis A.J., Gdalia M., Muriel E., Dgani R., Zbar A.P.: “Ureteral obstruction and reconstruction in pelvic actinomycosis”. Urology, 2003, 61, 224.

[17] Fulton I.C., Paterson W.G., Crucioli V.: “Pelvic actinomycosis causing ureteric obstruction: case reports”. Br. J. Obstet. Gynaecol., 1981, 88, 1044.

[18] Brown R., Bancewicz J.: “Ureteric obstruction due to pelvic actinomycosis”. Br. J. Surg., 1982, 69, 156.

[19] Haj M., Nasser G., Loberant N.: “Pelvic actinomycosis presenting as ureteric and rectal stricture”. Dig. Surg., 2000, 17, 414.

[20] Rose G., Franke F.E. , Weimar B., Buhr J., Padberg W.: “Actinomycosis of the colon as a rare differential diagnosis of colonic carcinoma”. Chirurgia, 2000, 71, 93.

[21] Huang C.J., Huang T.J., Hsieh J.S.: “Pseudo-colonic carcinoma caused by abdominal actinomycosis: report of two cases”. Int. J. Colorectal Dis., 2004, 19, 283.

[22] Brown J.R.: “Human actinomycosis: A study of 181 subjects”. Hum. Pathol., 1973, 4, 319.

[23] Ha H.K., Lee H.J., Kim H., Ro H.J., Park Y.H., Cha S.J., Shinn K.S.: Am. J. Roentgenol., 1993, 161, 791.

[24] Hawnaur J.M., Reynolds K., McGettigan C.: “Magnetic Resonance imaging of actinomycosis presenting as pelvic malignancy”. Br. J. Radiol., 1999, 72, 1006.