Colonic Diffuse Large B-cell Lymphoma Hidden in Actinomycosis

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon...

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Bibliographic Details
Published inThe Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi Vol. 74; no. 1; p. 46
Main Authors Lee, Sang Hoon, Nam, Seung-Joo, Lee, Sung Joon, Park, Sung Chul, Kang, Chang Don, Choi, Dae Hee, Park, Jin Myung, Lee, Seung Koo
Format Journal Article
LanguageEnglish
Published Korea (South) 25.07.2019
Subjects
Abdomen - diagnostic imaging
Actinomycosis - complications
Actinomycosis - diagnosis
Actinomycosis - drug therapy
Aged
Anti-Bacterial Agents - therapeutic use
Colon, Ascending - pathology
Colonoscopy
Female
Humans
Lymphoma, Large B-Cell, Diffuse - complications
Lymphoma, Large B-Cell, Diffuse - diagnosis
Penicillins - therapeutic use
Tomography, X-Ray Computed
Actinomycosis
Colonoscopy
diffuse
Colonic neoplasms
large B-Cell
Lymphoma
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Summary:Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
ISSN:2233-6869