Cao Yidan, Wu Weilu, Wang Wei, Liu Tianmin, Liang Dongni
Department of Pathology, West China Second Hospital of Sichuan University Chengdu 610041, Sichuan, P. R. China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education Chengdu 610041, Sichuan, P. R. China.
Int J Clin Exp Pathol. 2023 Jul 15;16(7):158-163. eCollection 2023.
Actinomycosis is an actinomycete infection, a rare zoonotic disease characterized by chronic suppurative inflammation and granulomatous inflammation. When injury occurs to the mucosa where parasites are present, actinomycetes can invade the mucosa. Widespread use of intrauterine devices (IUDs) has increased the incidence rate of pelvic actinomycosis among women. The clinical manifestation of ovarian actinomycosis is mostly a solid or cystic ovarian mass, which can invade surrounding tissue and may be accompanied by elevated levels of the tumor marker cancer antigen 125 (CA125). Therefore, ovarian actinomycosis is easily misdiagnosed as a malignant ovarian tumor.
Three cases of ovarian actinomycosis diagnosed in the Department of Pathology of the West China Second University Hospital of Sichuan University from January 2020 to March 2022 were retrospectively analyzed. All 3 patients had a history of IUD implantation for more than 10 years. All patients presented with abdominal masses and abdominal pain. One patient had weight loss, and 2 patients had elevated tumor marker CA125. Imaging results showed that all patients had ovarian space-occupying lesions involving the surrounding tissue; therefore, all patients were suspected to have malignant ovarian tumors before surgery. All 3 patients underwent surgical treatment. Specifically, 1 patient underwent bilateral salpingo-oophorectomy, and 2 patients underwent total hysterectomy and bilateral salpingo-oophorectomy. All patients received high-dose antibiotic treatment after surgery, and thus far, relapse has not been observed. Postoperative pathologicexamination showed purulent inflammation and sulfur granules, consistent with ovarian actinomycosis. Anaerobic culture was positive for 1 patient.
Ovarian actinomycosis is closely related to long-term IUD implantation. The clinical manifestations and imaging features of this disease are not specific; therefore, preoperative diagnosis is difficult. The disease is easily misdiagnosed as ovarian cancer. Sulfur granules are signs of ovarian actinomycosis, and thus, those with this manifestation should be carefully screened by pathologic examination. Surgery combined with antibiotic treatment is effective for ovarian actinomycosis, resulting in a good prognosis.
放线菌病是一种放线菌感染，是一种罕见的人畜共患病，其特征为慢性化脓性炎症和肉芽肿性炎症。当存在寄生虫的黏膜发生损伤时，放线菌可侵入黏膜。宫内节育器（IUD）的广泛使用增加了女性盆腔放线菌病的发病率。卵巢放线菌病的临床表现多为卵巢实性或囊性肿块，可侵犯周围组织，且可能伴有肿瘤标志物癌抗原125（CA125）水平升高。因此，卵巢放线菌病易被误诊为卵巢恶性肿瘤。
回顾性分析了2020年1月至2022年3月在四川大学华西第二医院病理科诊断的3例卵巢放线菌病病例。所有3例患者均有IUD植入史超过10年。所有患者均表现为腹部肿块和腹痛。1例患者有体重减轻，2例患者肿瘤标志物CA125升高。影像学结果显示，所有患者均有累及周围组织的卵巢占位性病变；因此，所有患者在手术前均被怀疑患有卵巢恶性肿瘤。所有3例患者均接受了手术治疗。具体而言，1例患者接受了双侧输卵管卵巢切除术，2例患者接受了全子宫切除术及双侧输卵管卵巢切除术。所有患者术后均接受了大剂量抗生素治疗，迄今为止，未观察到复发。术后病理检查显示为化脓性炎症和硫磺颗粒，符合卵巢放线菌病。1例患者厌氧培养呈阳性。
卵巢放线菌病与长期IUD植入密切相关。该疾病的临床表现和影像学特征不具有特异性；因此，术前诊断困难。该疾病易被误诊为卵巢癌。硫磺颗粒是卵巢放线菌病的征象，因此，有此表现者应通过病理检查仔细筛查。手术联合抗生素治疗对卵巢放线菌病有效，预后良好。
