Pelvic actinomycosis infection masquerading as recurrent endometrial cancer

Abstract

This case report presents a perplexing case of Actinomycosis infection in a patient undergoing routine surveillance after surgical treatment of endometrial cancer 10 years earlier. Her history was significant for recurrence of endometrial cancer in the vaginal vault after one year which was treated with radiation therapy.During routine surveillance follow up, a periurethral mass was noted on bimanual and speculum examination approximately 9 years after the last recurrence. It was suspected to be a recurrence of endometrial cancer based on the appearance of lesion and the patient's history of recurrent cancer. The mass was biopsied and sent only for tissue pathology, which was resulted as Actinomyces on background of necrotic tissue and absence of malignant cells.The patient was started on oral antimicrobial agents effective against Actinomycosis with the intention of repeating the bimanual and speculum examination and performing a CT scan after an appropriate duration of treatment to evaluate for resolution of mass indicating treatment of cure.This case demonstrates the need to consider the possibility of pelvic actinomycosis infection in patients with radiation induced injury to vaginal mucosa in absence of other known risk factors.

Keywords

• Actinomyces
• Actinomycosis
• Recurrent endometrial cancer
• Urinary incontinence
• Radiation cystitis
• Radiation injury