Differential diagnostics of pelvic actinomycosis with advanced gynaecological cancer

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Objective: Actinomycosis is filamentous gram-positive anaerobic bacterium. Clinically, actinomycosis can mimic malignancy. The differential diagnosis with carcinoma is difficult. The aim of our exploration is definition of history's clinical pathological and biological analyses' significance.

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Methods: We analyzed all the records of 9 women (mean 43,2 years). 4 of then had intrauterine devices (IUD) for the previous 4-8 years. All patients presented leukocytosis, fever, anemia. The clinical examination showed a palpable hypogastric mass. Ultrasound and computed tomography showed an unilateral or bilateral large masse arising from adnexum, adherent to the uterus and compressing the urinary bladder with peritoneal carcinomatosis.

Results: A preoperative diagnosis of advanced ovarian cancer was made. Laparotomy reveled a large inflammatory mass involving uterus, adnexa and other pelvic structures. Bilateral salpingoophorectomy and total abdominal hysterectomy were performed. After pathological analyses, actinomycosis was diagnosed (was detected specific actinomycotic granuloma). All patients were treated postoperatively with ampicillin.

Conclusions: Pelvic actinomycosis is a rare inflammation which clinically and radiologically can successfully mimic ovarian cancer. Differential diagnosis is difficult but some symptoms such as leukocytosis, fever, history of IUD use, absence of serum tumor markers, typical inflammatory appearance during surgery should prompt a diagnosis of actinomycosis. An intraoperative frozen section should be obligatory for all patients. Culture methods of diagnosis, Gram-Veigert staining, hematoxylin staining should be used followed by histological verification.