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Abstract
Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anae-robic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.
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Fig. 1.
Computed tomography scan images. (A) Multiple calcifications and stones (black arrows) were also noted in the head of the pancreas. (B) Contrast-enhanced axial image (portal phase) revealed diffuse parenchymal swelling with multiple calcification (black arrows) at the body of the pancreas. (C) Contrast-enhanced coronal image (portal phase) showed heterogeneous enhancement of the pancreas parenchyma and peripancreatic strands (white arrows). (D) Multifocal uneven pancreatic duct dilation (white asterisk) was also observed.
Fig. 2.
Endoscopic ultrasonography (EUS) images. (A) A 19-mm sized, ill-defined, hypoechoic and heterogenous mass with central calcification was identified at the pancreatic tail. (B) EUS-guided fine needle aspiration biopsy using a 20-gauge needle was performed.
Fig. 3.
Microscopic findings for the specimen. The specimen revealed sulfur granules, consisting of a conglomeration of filamentous bacteria, which was shown at the surrounding tissue with dense inflammatory infiltration by lymphocytes, neutrophils, and foamy macrophages (A, hematoxylin and eosin stain, ×100; B, hematoxylin and eosin stain, ×400).
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