Surgery for Inflammatory Tumor of the Lung Caused by Pulmonary Actinomycosis

Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany.
The Thoracic and Cardiovascular Surgeon (Impact Factor: 0.98). 06/2011; 60(2):156-60. DOI: 10.1055/s-0030-1271180
Source: PubMed


Actinomycosis is an uncommon chronic suppurative bacterial infection caused by anaerobic bacteria. Pulmonary actinomycosis is even more infrequent and generally simulates a wide variety of pulmonary disorders including tuberculosis and lung cancer. Therefore delayed diagnosis and misdiagnosis is common. Here, actinomycosis was initially confused with pulmonary carcinoma.
We report on three cases of inflammatory tumors caused by pulmonary actinomycosis. All three patients were male and had a history of alcoholism and poor oral hygiene associated with dental disease. Clinical symptoms were nonspecific and radiographic imaging showed tumor-like mass lesions not distinguishable from neoplasms. Preoperative bronchoscopy, sputum culture, laboratory tests and bronchoalveolar lavage neither confirmed an infectious disease nor ruled out lung cancer. Hence all patients underwent thoracotomy for both diagnosis and definitive treatment. Intraoperatively we encountered a necrotizing infection forming cavitary as well as tumorous lesions and a lobectomy was performed due to destroyed lung tissue. In one case the tumorous lesion involved the chest wall so that partial resection of the 3rd rib with the adjacent soft tissue was mandatory.
Histological examination of the pulmonary specimen established the diagnosis of pulmonary actinomycosis. All patients recovered well and received antibiotic therapy with oral penicillin.
The diagnosis of pulmonary actinomycosis remains challenging. In cases of an inflammatory tumor imitating lung cancer, surgical resection is mandatory, both to confirm the diagnosis and for the definitive treatment in cases with irreversible parenchymal destruction. Here, surgery in combination with medical treatment offered reliably excellent results.

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    • "The surgical technique of VATS, except for lung biopsy [20], is a curative treatment of non-invasive inflammatory pseudotumor [7], which is useful for patients with deranged lung function. In case of pulmonary infectious diseases mimicking lung cancer, surgical curative methods such as classical thoracotomy or VATS technique are also used [8,9]. According to the relevant literature [9,21,22], pulmonary infections, specifically pulmonary actinomycosis, enhance immunodeficiency and contribute to cavitary lesion occurrence. "
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    ABSTRACT: Patient: Female, 60Final Diagnosis: Inflammatory pseudotumor of the lungSymptoms: Cough dry • feverMedication: —Clinical Procedure: —Specialty: —Objective:Rare diseaseBackground:Inflammatory pseudotumor of the lung involves a benign, non-neoplastic lung lesion of unknown etiology.Case Report:We present a case of a 60-year-old female smoker who had been under intermittent immunosuppressive medication for discoid lupus, who was admitted to hospital with fever of 39.5°C of 10-day duration, not responding to an oral cephalosporin. Chest CT examination showed a cavitating opacity in the upper zone of the left lung. It was not feasible to establish a diagnosis based on clinical and laboratory testing nor based on CT scanning and bronchoscopy. Thus, the patient underwent left thoracotomy and sphenoid resection of the lesion, which was sent for biopsy. The histopathologic features aided by immunohistochemical staining proved the lesion to be an inflammatory pseudotumor of the lung.Conclusions:The case is reported because of the extremely rare radiologic presentation of the development of a lung pseudotumor emerging as a cavitated lesion, which relapsed during the follow-up period while the patient was still under immunosuppressive medication.
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    ABSTRACT: Pulmonary actinomycosis is a rare and slowly progressing bacterial lung infection. Actinomyces are commensal bacteria of the oropharynx. Risk factors for pulmonary infection include aspiration and poor dental hygiene; it is not necessarily associated with an immunosuppressed state. Radiological and clinical appearances are nonspecific and mimic a variety of other lung diseases including cancer. Diagnosis requires microbiological isolation of the bacteria from an infected specimen or histopathological evidence of sulfur granules, usually obtained after bronchoscopic, transthoracic or surgical biopsy. Long-term and high-dose antibiotic treatment is essential to achieve high clinical cure rates and good prognosis. Penicillin remains the drug of choice; doxycycline, macrolides and clindamycin have been used successfully as alternatives. Duration of antibiotic treatment should be individualised according to the resolution of symptoms and radiological lesions. Surgical treatment is reserved for patients developing complications, such as massive haemoptysis or empyema, and for those in whom a medical diagnosis cannot be established.
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