Omental Actinomycosis Coexisting with Colon Cancer
- Affiliations
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- 1Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea. limmhm@kornet.net
- 2Department of Pathology, College of Medicine, Chung-Ang University, Seoul, Korea.
- KMID: 1464794
- DOI: http://doi.org/10.4174/jkss.2009.77.Suppl.S17
Abstract
- Actinomycosis is a rare infection caused by Actinomyces species, normal commensal inhabitants of the human bronchial and gastrointestinal tract. Infection occurs after preceding mucosal break-down by variable causes. A preoperative diagnosis is difficult because of its nonspecific clinical features, mimicking malignancy, tuberculosis or other inflammatory diseases. We report a case of abdominal actinomycosis presenting as an omental mass, which coexists with ascending colon cancer. Actinomycosis was diagnosed by histopathologic demonstration of sulfur granules in a specimen resected by laparoscopic exploration. Following surgery, the patient was treated with IV penicillin (20 million IU/day) for 3 weeks, and follow-up colonoscopy showed adenocarcinoma in the ascending colon. The patient underwent right hemicolectomy, then treated with intravenous penicillin for 4 weeks postoperatively and oral penicillin for 6 months. The patient has been free of recurrence for 6 months.
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Figure
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Fig. 1 (A) Abdomino-pelvic computed tomography shows 3.3×2 cm ill defined soft tissue density in left-sided omentum with enhancement and 1.7 cm internal linear high density (white arrow). (B) Abdominal ultrasonography shows about 3 cm infiltrative ill defined hypoechoic lesion in left abdominal wall and omentum (white arrows).
Fig. 2 (A) Omental abscess resected by laparoscopic approach. (B) Intraoperative finding shows multiple small abscess formations located through omentum.
Fig. 3 Lesion shows characteristic surfur granules and inflammatory reaction (H&E, ×200) (A). Sulfur granule is composed of radiating small slender fillamentous organisms (Gomori methenamine silver stain, ×400) (B).
Fig. 4 Colonoscopic examination shows 2 cm protruding mass lesion in ascending colon, suggesting cancer.
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