Differentiating pelvic actinomycosis from advanced ovarian cancer: a report of two cases, management reflections and literature review

Abstract

Pelvic actinomycosis comprises a rare, subacute to chronic bacterial infection characterised by suppurative and granulomatous inflammation. Diagnosis is difficult as it may simulate pelvic malignancies. Laboratory and radiological findings are non-specific. We reported on 2 cases of pelvic actinomycosis mimicking ovarian malignancy with different management approaches that lead to opposite outcomes. We reviewed the literature on pelvic actinomycosis imitating ovarian cancer with a focus on its surgical management. Despite agreement on the duration of antibiotic therapy following surgical management, consensus regarding surgical approach was rather equivocal. We concluded that pelvic actinomycosis should be strongly suspected in women with presumed ovarian cancer of atypical presentation and a history of intrauterine devices (IUD).Electronic supplementary materialThe online version of this article (doi:10.1186/2053-6844-1-5) contains supplementary material, which is available to authorized users.

Pelvic Actinomycosis Mimicking Pelvic Malignancy

“…11 A diagnosis of advanced ovarian cancer is often assumed and these patients are subjected to unnecessary exploratory laparotomy. 2,3,11 The need of an intraoperative frozen section to distinguish actinomycosis and other benign processes from ovarian carcinoma must be emphasized to prevent complete staging procedures, pelvic and para-aortic lymphadenectomy, and the morbidity that follows. 2 The final diagnosis is based on the recognition of actinomycotic sulfur granules on histology and/or on cultural identification of Actinomyces.…”

Mimicking uterine malignancy: Pelvic actinomycosis with giant uterine leiomyoma

“…About 20 % of reported cases of actinomycosis is abdominopelvic actinomycosis [ 4 ]. Pelvic actinomycosis most often associate with intrauterine device (IUD) use [ 5 ]. The clinical symptoms of pelvic actinomycosis include fatigue, fever, weight loss and lower abdominal pain, sometimes associated with a palpable mass.…”

Pelvic actinomycosis mimicking an advanced ovarian carcinoma: a rare case report with review of literature

“…Actinomycosis is a rare subacute to chronic granulomatous bacterial infection caused by actinomyces species. 1,2 These are gram positive, non-acid fast anaerobic bacteria normally constituting the human flora in the oropharynx, gastrointestinal and genital tract. 3 Pelvic actinomycosis constitutes 3% of all human actinomycosis infections and occurs almost only in women.…”

“…3 Pelvic actinomycosis constitutes 3% of all human actinomycosis infections and occurs almost only in women. 2,4 It may simulate pelvic malignancies or retroperitoneal tumours which often makes it difficult to diagnose preoperatively. 2 Here, we report a case in which pseudotumor and pelvic masses resulting from actinomycosis were initially suspected to be malignant.…”