Table 1.

Summary of large studies and literature reviews regarding treatment outcomes of pseudotumoral actinomycosis

Author/year	Country	Study type	n	Management and main findings
Târcoveanu et al. [23], 2019	Romania	Retrospective cohort	13	− Preoperative diagnosis is established in less than 10% of cases and can avoid surgery − The clinical presentation is similar to that of chronic inflammatory and malignant diseases − Laparotomy or laparoscopy + intravenous penicillin therapy (2–6 weeks) followed by 6 months of oral penicillin is recommended − Postsurgery follow-up is required as relapse is possible
Wacharachaisurapol et al. [7], 2017	Thailand	Case report and review of 18 previous cases	19	− Abdominal pain and lump/mass dominate the clinical presentation mimicking malignant tumors − The majority of reported cases required exploratory surgery − Penicillin use is the gold standard for postoperative parenteral treatment
García-García et al. [13], 2017	Mexico	Systematic review	86	− Intrauterine device may be incriminated in the pathogenesis of this entity and must be changed regularly − Diagnosis is often made after postsurgical interventions − Actinomycosis is confused with chronic inflammatory lesions and tumors − The presence of clinical symptoms is often associated with advanced disease stages
Lisa-Gracia et al. [10], 2017	Spain	Prospective cohort	13	− Risk factors for appendiceal actinomycosis include no antecedents of carcinoma (p = 0.034) and previous incorrect diagnosis (p = 0.006) − As expected, appendiceal actinomycosis has a very variable and nonspecific clinical presentation and surgery was offered to all patients with good evolution
Pierre et al. [9], 2014	France	Retrospective cohort	33	− Immunosuppression in immunocompromised patients with invasive actinomycosis significantly predicts poor outcomes in this population (p = 0.027)
Sung et al. [24], 2011	South Korea	Retrospective cohort	23	− 50% of the patients presented to the emergency department with symptoms of peritonitis − Included subjects commonly had preoperative computerized tomography findings in favor of masses with abscess and malignancy behavior − Best results are achieved by combining short-term antibiotic therapy and surgical resection − No recurrence was seen after 30 months of clinical follow-up
Choi et al. [25], 2009	South Korea	Retrospective cohort	22	− 60% of patients had intrauterine device − 50% of patients benefited from surgery because of peritonitis − Only 2 patients had features of malignant colon tumors − Definitive diagnosis could not be made based on radiological findings − Penicillin IV is the treatment of choice for a period of 3–6 months after surgical removal