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      Hepatic Actinomycosis Mimicking Malignancy After Pancreaticoduodenectomy: A Case Report

      case-report
      Author(s): 1 , , 1 , 2 , 2 , 3
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: liver actinomycosis, hepatic pseudotumor, granulomatous disease, hepatic neoplasm, actinomyces infection

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          Abstract

          Abdominal actinomycosis is a rare disease caused by a Gram-positive bacillus (Actinomyces). Liver manifestation is rare and, in patients with a history of cancer, differential diagnosis with secondary malignant disease can be difficult. Microbiological result is necessary for a correct diagnosis, though not always possible in preoperative workout. The authors present a case of hepatic actinomycosis that mimicked oncological disease and led to a more aggressive surgical approach.

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          The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.

          Stephen B. Edge, Carolyn C. Compton (2010)
          The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.
          Article 0 comments Cited 1203 times – based on 0 reviews     Review now
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            Abdominal actinomycosis.

            Andrew J. P. Garner, Erin Macdonald, P K Kumar (2007)
            Abdominal actinomycosis has been recognised for over 150 years yet remains largely unknown to most clinicians. It's varied presentations are usually considered to represent malignancy rather than an infective process - and was once described as 'the most misdiagnosed disease'. Actinomyces are gram positive bacilli of the Actinomycetales genus, and A. israelii is responsible for the majority of human disease. They are normal commensal inhabitants of the human bronchial and gastrointestinal tracts and seem to only cause pathological infection after preceding mucosal breakdown. Patients who have undergone appendicectomy, have had a missed perforated appendicitis or women with a history of intrauterine contraceptive device use are at an increased risk. Florid abscess formation with fistulation, abundant granulation and dense surrounding fibrosis are common. Diagnosis prior to, or even during, surgery is rare and the findings are usually mistaken for acute inflammatory pathologies or malignancy. The treatment of choice is prolonged antibiotic therapy, usually with penicillin to which the organisms remain exquisitely sensitive, although delayed recurrence is possible. This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis.
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              Hepatic actinomycosis: an overview of salient features and outcome of therapy.

              Mamta Sharma, Jessica Briski, Riad Khatib (2001)
              A 34-y-old African-American male developed Actinomyces liver abscess 8 months after appendectomy. Review of the English language literature revealed 56 additional cases of hepatic actinomycosis. Affected patients were typically immunocompetent, had a wide age range (4-86 y) and were predominantly male (70.2%). Infection was frequently (80.7%) cryptogenic, presenting with fever (83.3%), abdominal pain (74.5%) and weight loss (50.9%) over a 3.7 +/- 5.1 month period. The most common radiographic finding was a single hypodense mass/abscess (68.4%). Extension to surrounding tissues was evident in 19 cases (33.3%). Diagnosis was usually accomplished microscopically and culture was often (33.3%) negative. Infection was often (35.2%) mixed, usually with anaerobic bacteria. A surgical or percutaneous approach was diagnostic in 29/35 (82.9%) and 24/33 (72.7%) cases, respectively. The overall mortality rate was 8.8%; it was 10.7% with medical therapy alone and 4.0% using a combined medical/intervention approach (p = 0.6). In conclusion, hepatic actinomycosis is a rare subacute infection that may mimic neoplasm. It is usually cryptogenic, is more common among immunocompetent individuals and male subjects and is highly responsive to medical therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 14 January 2022
                Publication date (Electronic, collection): January 2022
                Volume: 14
                Issue: 1
                Electronic Location Identifier: e21234
                Affiliations
                [1 ] General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
                [2 ] General Surgery, Champalimaud Foundation, Lisbon, PRT
                [3 ] General Surgery, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT
                Author notes
                Article
                DOI: 10.7759/cureus.21234
                PMC ID: 8844254
                SO-VID: d8334d70-0259-44c3-9a69-0d489e1612cb
                Copyright © Copyright © 2022, Frutuoso et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 12 January 2022
                Categories
                Subject: Radiology
                Subject: Gastroenterology
                Subject: General Surgery

                Keywords: liver actinomycosis,hepatic pseudotumor,granulomatous disease,hepatic neoplasm,actinomyces infection
                Data availability:
                Keywords: liver actinomycosis, hepatic pseudotumor, granulomatous disease, hepatic neoplasm, actinomyces infection

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