Diagnostic Challenges and Clinical Implications in Differentiating Pelvic Organ Inflammatory Pseudotumors Caused by Malignant Actinomyces Infection: Insights from a Case Series

Introduction

Inflammatory pseudotumor (IP) is characterized by an abnormal immune response that presents as tumor masses. They grow slowly and sometimes destroy neighboring structures. Chronic Actinomyces infections are a rare cause among the many factors that can play a role in developing an inflammatory pseudotumor [Sedlic T et al. Can Assoc Radiol J. 2014; 65(1): 52–59]. Actinomycosis is a granulomatous bacterial infection characterized by inflammation, sinus fistula formation, and fibrosis. Pelvic actinomycosis mimics pelvic malignancy and may be associated with the long-term use of intrauterine contraceptive devices [Han Y et al. Am J Case Rep. 2020; 21: e922601, Laios A et al. Gynecol Oncol Res Pract. 2014; 1: 5]. Pelvic actinomycosis is an infrequent chronic infection that is difficult to diagnose. Furthermore, accurate diagnosis can reduce complications and unnecessary surgeries which may result in infertility. Therefore, pelvic actinomycosis should always be considered in patients with a pelvic mass, especially those with an IUCD, whose tumor markers are normal or minimally high and atypical radiological changes on imaging.

Publication History

Received: 06 October 2024

Accepted after revision: 21 January 2025

Article published online:
18 February 2025