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Korean J Gastroenterol  <  Volume 74(1); 2019 <  Articles

Korean J Gastroenterol 2019; 74(1): 46-50  https://doi.org/10.4166/kjg.2019.74.1.46
Colonic Diffuse Large B-cell Lymphoma Hidden in Actinomycosis
Sang Hoon Lee, Seung-Joo Nam , Sung Joon Lee, Sung Chul Park, Chang Don Kang, Dae Hee Choi, Jin Myung Park and Seung Koo Lee1
Departments of Internal Medicine and Anatomic Pathology1, Kangwon National University School of Medicine, Chuncheon, Korea
Correspondence to: Seung-Joo Nam, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon 24341, Korea. Tel: +82-33-258-2405, Fax: +82-33-258-2146, E-mail: pinetrees@hanmail.net, ORCID: https://orcid.org/0000-0002-0349-0901
Received: February 10, 2019; Revised: April 4, 2019; Accepted: April 29, 2019; Published online: July 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Lymphoma, large B-Cell, diffuse; Actinomycosis; Colonic neoplasms; Colonoscopy


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