CASI CLINICI   

Chirurgia 2015 April;28(2):81-4

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Gastrointestinal basidiobolomycosis mimicking a right colon cancer treated using a laparoscopic approach and antifungal therapy

Monsellato I. ¹, Uccelli F. ¹, Sonzogni A. ¹, Parravicini C. ², Petz W. ¹, Bianchi P. P. ¹

¹ EIO – European Institute of Oncology, Milan, Italy; ² Luigi Sacco University Hospital, Division of Pathology, Milan, Italy

Basidiobolomycosis is a rare infection caused by Basidiobolus Ranarum often involving the subcutaneous fat tissue and, rarely, the gastrointestinal tract. Its clinical presentation may mimic some neoplasms and its treatment remains still controversial. A 24-year-old Italian man presented in our outpatient clinic with right lower quadrant pain and fever since 2 months. Abdominal CT-scan revealed a large mass in the right iliac fossa involving the cecum and the last ileal loop. Colonoscopy confirmed a severe stenosis of the lumen of the cecum with mucosal ulceration. A laparoscopic right colectomy with complete mesocolic excision was successfully performed. Histopathology showed a diffused granulomatous reaction with many broad, thick septate fungal hyphae surrounded by eosinophilic reaction (Splendore-Hoeppli phenomenon), suggesting a fungal infection by Basidiobolus ranarum. Laparoscopic right colectomy was easily performed with neither intraoperative nor postoperative complications. Moreover, neither spread nor increase of the infection was experienced in the postoperative and the patient was discharged early. Association of surgical and antifungal treatment seems to be the best approach to eradicate the infection. Laparoscopic resection, thanks to low rates of postoperative complications and early discharge, could be a potential benefit to patient suffering from this disease, favouring a quick start of medical therapy.