A Large Adnexal Tumor Caused by Enterobius Vermicularis Mimicking Malignancy.

Enterobius vermicularis usually causes trivial infections in the juvenile population. However, its extragenital presentation in adults is relatively rare. We present the case of a 64-year-old female suffering from poorly controlled diabetes and lower abdominal pain. CT scan showed a large tumorous expansion of the lower abdomen, mimicking malignancy. Perioperative findings revealed a large adnexal tumor adhering to the rectum. In addition, the histological examination uncovered a mixed inflammatory infiltrate with multiple surrounding eggs of the parasite and granulomatous reaction in the left fallopian tube and left ovarian cortex. As reported in our article, the rare ectopic sites of Enterobius vermicularis in postmenopause may become a diagnostic challenge.

Pelvic actinomycosis and IUD.

OBJECTIVE: To summarize knowledge about the mana-gement in women with proven actinomyces in uterine cervix and inserted intrauterine device (IUD). DESIGN: An overall review. RESULTS: Actinomycosis is an uncommon but important subacute or chronic infection caused by anaerobic or microaerophilic bacteria, mainly within the Actinomyces genus. Actinomycosis can affect various organs and tissues in the human body, often manifesting draining sinuses, abscess formation and fibrosis. The pelvic form in women is the most common in the developed countries. Long-duration treatment with antibiotics can be completely effective even in cases of heavy disease. Although pelvic actinomycosis is predominantly associated with the longstanding use of intrauterine device, the risk of future symptomatic infection is extremly low even in women with a cervical Pap smear positive for actinomyces-like organisms (ALO). Therefore the identification of actinomycetes by cytology after cervical Pap smears is not diagnostic nor predictive of any disease because the actinomycetes normally reside in the female genital tract. In the absence of symptoms, patients with ALO on a Pap test do not need antimicrobial treatment or IUD removal. Nevertheless, women choosing an IUD for contraception should know that there is very low risk of developing the infection in later years after insertion. CONCLUSION: The sources of literature conclude that removal of the intrauterine device in a patients with a positive ALO in the uterine cervix is not necessary and antibiotics treatment is not required. However, IUD must be changed at least every five years in order to limit the risk of the development of pelvic actinomycosis.