Omental actinomycosis misdiagnosed as ovarian cancer peritonei

Abstract

With reference to the report by Kim et al [1], we also experienced a rare case of omental actinomycosis. Kim et al [1] reported pelvic actinomycosis with abundant ascites comparable to cancer. Our case provides an educational tip for the gynecologist who has to manage pelvic actinomycosis misdiagnosed as ovarian cancer. A 49-year-old woman was transferred from a local clinic with a working diagnosis of right ovarian cancer and multiple myomas. The patient was para 5-2-2-3 and the family history was noncontributory. She was postmenopausal. She had not taken a gynecological examination for almost 5 years. The pelvic examination revealed a huge uterus, an intrauterine device (IUD) that had been inserted for 10 years, and motion tenderness of the cervix. The physical examination revealed mild diffuse abdominal tenderness. We removed the IUD during the pelvic examination. The following laboratory results were reported: white blood count 15.1 103/mL; hemoglobin/hematocrit 11.9 g/dL/33.9%; platelets 637 103/mL; prothrombin time international normalized ratio 1.10; activated partial thromboplastin time 28.2 seconds; carcinoembryonic antigen 2.2 ng/mL; and CA125 84.8 U/mL. Computed tomography (CT) revealed what appeared to be right ovary cancer with a secondarily perforated appendix or a ruptured malignant mucinous neoplasm of the appendix and multiple uterine myomas (Figures 1A and 1B). Ultrasonography revealed multiple uterine myomas. An exploratory laparotomy revealedmultiple abscesses in the omentumand a periappendiceal abscess involving the cecum and terminal ileum. At surgery, no tumor-likemasswas seen in the omentum, ovary, or any pelvicorgan.Thereweremultipleomentalabscesses.