Urachal actinomycosis mimicking a urachal adenocarcinoma: case report and systematic review

Abstract

Actinomycosis is a chronic bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium typically found in the oral cavity and gastrointestinal tract. This infection can present in various clinical and radiological forms, affecting cervicofacial, thoracic, abdominal, and pelvic regions, often resembling malignancies. This extremely rare disease should be considered in the differential diagnosis of abdominopelvic masses. Accurate identification and appropriate management are challenging and depend on the clinician's suspicion. Most patients undergo surgery, and are treated concomitantly with antimicrobials; however, some studies have proven the potential of a strictly medical approach. Both surgical resection and targeted antibiotic therapy have shown to be successful treatments, with no recurrence rates reported. Therefore, increased clinical awareness and further research are needed to establish standardised diagnostic and treatment protocols that prevent unnecessary invasive treatments. The present Grand Round aims to report a rare case of a urachal mass in a man aged 64 years, with clinical, endoscopic, and radiological findings suggestive of adenocarcinoma. We also conducted a systematic review focused on the main presentations and treatment options.