Korean J Gastroenterol.  2019 Jul;74(1):46-50. 10.4166/kjg.2019.74.1.46.

Colonic Diffuse Large B-cell Lymphoma Hidden in Actinomycosis

• Lee SH
• Nam SJ
• Lee SJ
• Park SC
• Kang CD
• Choi DH
• Park JM
• Lee SK

• KMID: 2453258
• DOI: http://doi.org/10.4166/kjg.2019.74.1.46

Abstract

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.

Keyword

Lymphoma, large B-Cell, diffuse; Actinomycosis; Colonic neoplasms; Colonoscopy

MeSH Terms

Actinomycosis*
Aged
B-Lymphocytes*
Biopsy
Colon*
Colon, Ascending
Colonic Neoplasms
Colonoscopy
Diagnosis
Drug Therapy
Female
Flank Pain
Follow-Up Studies
Humans
Lymphoma
Lymphoma, B-Cell*
Lymphoma, Large B-Cell, Diffuse
Masks
Penicillin G
Sulfur
Tomography, X-Ray Computed
Weight Loss
Penicillin G
Sulfur

Figure

• 

  Fig. 1 Abdominal computed tomography scan shows a huge mass at the ascending colon with nearby multiple enlarged lymph nodes.

• 

  Fig. 2 Colonoscopy shows a huge ulcerative mass with luminal narrowing at hepatic flexure.

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  Fig. 3 (A) Histology examination showing inflammatory necrotic tissues (H&E, ×100). (B) Silver special staining revealing the filamentous bacterial colonies (arrows) (GMS, ×400).

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  Fig. 4 In the follow-up abdominal computed tomography examination, size of the colonic mass increased significantly and multiple new nodules (arrows) were observed around the ascending colon.

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  Fig. 5 Pathological findings of the tumor revealed sheets of atypical large pleomorphic lymphoid cells with prominent nucleoli and apoptotic bodies (A; H&E, ×400) with pan-B cell marker expression (B; CD20, ×100).

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