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CASE REPORT
Year : 2011  |  Volume : 27  |  Issue : 4  |  Page : 545-546

Actinomycosis in urachal remnants: A rare cause of pseudotumor


1 Department of Pathology, St. John's Medical College and Hospital, John Nagar, Bangalore, India
2 Department of Surgery, St. John's Medical College and Hospital, John Nagar, Bangalore, India
3 Department of Radiology, St. John's Medical College and Hospital, John Nagar, Bangalore, India
4 Department of Medicine, St. John's Medical College and Hospital, John Nagar, Bangalore, India

Correspondence Address:
T Rajalakshmi
Department of Pathology, St. John's Medical College and Hospital, John Nagar, Bangalore - 560 034
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.91450

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Actinomycosis is a chronic inflammatory condition caused by Actinomyces israeli, a gram positive anaerobic bacterium. It can have a variety of clinical manifestations and can mimic a malignancy. We present one such case of urachal actinomycosis that mimicked a tumor. A 28-year-old man presented with abdominal pain of 20 days duration. Per abdominal palpation revealed a firm mass with ill-defined borders in the suprapubic region. Computed tomography and magnetic resonance imaging scans of the pelvis showed an irregular lesion in the urinary bladder extending to the umbilicus, giving the impression of urachal remnants with inflammation. Peroperatively, an irregular, hard mass measuring 6 x 5 cm, involving the anterior and posterior bladder walls, the appendix, the terminal ileum and sigmoid colon, was seen, which was suspicious for a malignancy. Frozen sections from the mass showed extensive inflammation and a florid fibroblastic proliferation, giving the impression of an inflammatory pseudotumor. The tissue was extensively sampled for paraffin sections and only one of them revealed a colony of Gram, PAS and GMS- positive organisms, conclusive for Actinomycosis. It is important to be aware of this uncommon, yet significant, presentation of a common infectious disease in order to avoid misdiagnosis and over-treatment as a malignancy.


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