Tumour-Like Inflammatory Abdominal Conditions in Children

Abstract

The presence of a tumour, poor general condition, features of anaemia, increased erythrocyte sedimentation rates and imaging suggesting malignancy were the common features in 4 different tumour-like abdominal conditions that are extremely rare in childhood. These conditions included: extensive retroperitoneal tumour with rib involvement that turned out to be an inflammatory lesion caused by Actinomyces in a 12-year-old girl; multi-loculated tumour of the mesentery/ovary caused by mesenteric lymphadenopathy in the course of a Salmonella enteritidis infection in a 2.5-year-old girl; tumour of the VII - VIII hepatic segments that turned out to be the focus of granuloma in the course of lambliasis in a 5.5-year-old boy with a history of purulent neck lymphadenopathy and a final suspicion of immunocompromise; and a multi-loculated tumour of the small pelvis and inguinal area that turned out to be an abscess of the iliopsoas muscle in a 16-year-old boy. Apart from the imaging, the lesions required cytological examination of the material harvested by fine-needle biopsies (liver tumour) or histopathological investigations (retroperitoneal tumour, mesenteric/ovarian tumour, liver tumour and--on second surgery--the pelvic tumour) and/or bacteriological examination (all cases), serological examination (liver tumour and mesenteric/ovarian tumour), protozoal investigation (liver tumour), and measurement of AFP levels (mesenteric/ovarian tumour). Surgical treatment (retroperitoneal tumour, mesenteric/ovarian tumour and tumour of the small pelvis) and guided antibiotic therapy (all cases including 15 weeks of antibiotics in the first case) allowed complete recovery in 3 patients (actinomycosis, mesenteric lymphadenopathy, abscess of the iliopsoas muscle). Antibiotic and antiprotozoal therapy cured the granulomatous hepatitis; however this patient tended to develop severe right-sided pleural/pulmonary changes (the child was referred for further diagnosis with suspicion of immunocompromise).

Actinomycosis: a differential diagnosis for appendicitis

“…In children, abdominal infection caused by Actinomyces bacteria is rare. In a review of the English literature, we identified only 12 reports of children with abdominal AMC [6][7][8][9][10][11][12][13][14][15][16][17].…”

“…We present the case of a 13-year-old adolescent boy with appendiceal AMC who was admitted with right lower abdominal pain to our institution. In the English literature, we have found only 12 reports of patients with abdominal AMC [6][7][8][9][10][11][12][13][14][15][16][17]. In this article, the rare occurrence of AMC in a child is discussed, and the English literature on that disorder is briefly reviewed.…”

Actinomyces lymphadenitis: case report

“…It rarely causes disease (5). Actinomycosis may affect the cervicofacial, mediastinal, abdominal or pelvic regions (1,(6)(7)(8)(9)(10). The main step in the pathogenesis of actinomycosis is interruption of the mucocutaneus barriers leading to suppuration and abscess formation.…”

Pelvic Salmonella Infection Masquerading as Gynecologic Malignancy

“…These cases ranged from a 2.5-year old girl with mesenteric lymphadenopathy to a 42-year-old woman with a history of Salmonella osteomyelitis of the fifth vertebra. [5][6] Multiple cases reported infection in patients with a history of recent gastrointestinal distress, systemic lupus erythematosus (SLE) or endometriotic lesions. 3,7-8 Indeed, our patient had undiagnosed endometriotic ovarian cysts as reported on the final pathology report.…”