The aim of the study was to present a case of pelvic actinomycosis – a rare disease which is difficult to diagnose.
Case report: A 45-year-old woman was admitted to Riga East University Hospital for further investigation of possible cervical cancer.
Biopsy of the cervix and vagina, abrasion of uterine cavity was performed and there were no signs suggesting malignancy. Later, computed tomography (CT) of the abdomen with i/v contrast administration was performed, the radiologist`s conclusion was: cervical cancer with extension to uterus and vagina and specific parailiac lymphadenopathy. Loop electrosurgical excision procedure was also performed and showed only active cervicitis, no signs of malignancy. Urine cytology examination suspected cells that might be of oncological origin. Cystoscopy was made, nothing abnormal was found. The diagnosis was unclear, so magnetic resonance imaging (MRI) of small pelvis was performed, the conclusion was: massive malignant cervical process with parametrial infiltration spreading to pelvic walls, extension to uterus and possible infiltration of urinary bladder, advanced specific lymphadenopathy. Patient had negative HIV, HCV, HBV, borrelia burgdorferi and treponema pallidum test results.
It was decided to perform a diagnostic laparotomy with intraoperative lymph node histological investigation, which showed only reactive changes. Surgeons decided to perform total hysterectomy and tubectomy, preserving the ovaries, due to their intact state. Histology of postoperative material revealed chronic granulomatous cervicitis in reactivation phase with no signs of malignancy. Biological material cultured from vagina tested positive for Peptostreptococcus anaerobius and Actinomyces odontolyticus. Taking into consideration all findings, the most probable diagnosis of actinomycosis was established postoperatively. Therapy with antibiotics was prescribed and future MRI follow ups should show its effectiveness. Multidisciplinary approach is crucial to establishing this rare diagnosis, which mimics malignancy on radiological examinations.
- 3.4. Other publications in conference proceedings (including local)