Journal of Pathology and Translational Medicine

Case Study

Appendiceal actinomycosis mimicking appendiceal tumor, appendicitis or inflammatory bowel disease: You-Na Sung, Jihun Kim; J Pathol Transl Med. 2021;55(5):349-354. Published online June 26, 2020; DOI: https://doi.org/10.4132/jptm.2020.05.17

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Appendiceal actinomycosis is very rare and its diagnosis is often difficult even in surgically resected specimens. Here we report two cases of appendiceal actinomycosis confirmed by pathologic examination of surgically resected specimens. Characteristic histologic features included transmural chronic inflammation with Crohn-like lymphoid aggregates and polypoid mucosal protrusion into cecal lumen through fibrous expansion of the submucosa. Chronic active inflammation involved the mucosa of the appendix and cecum around the appendiceal orifice. Crohn’s disease with predominant cecal involvement and inflammatory pseudotumor were considered as differential diagnoses. Careful examination revealed a few actinomycotic colonies in the mucosa, confirming the diagnosis. A high index of suspicion with awareness of the characteristic histologic features might prompt careful inspection for the actinomycotic colonies, leading to the appropriate diagnosis of this rare disease.

Citations

Citations to this article as recorded by

Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal
Sujan Bohara, Manoj Khadka, Pawan Singh Bhat, Prajwal Syangtang, Badal Karki, Bhagawan Shrestha, Shoshan Arja Acharya, Khusbhu Khetan, Jyoti Rayamajhi, Sushil Bahadur Rawal
Clinical Case Reports.2023;[Epub] CrossRef
Abdominopelvic actinomycosis: An unexpected diagnosis in an elderly female with a destructive-appearing soft tissue mass
Elise Hyser, Drashti Antala, Harvey Friedman, Jonathan Stake
IDCases.2022; 28: e01479. CrossRef

Case Reports

Endobronchial Actinomycosis: A report of two cases.: Hye Seung Han, Kwang Ho Kim, In Seo Park, Jee Young Han, Young Bae Kim, Tae Sook Hwang, Young Chae Chu; Korean J Pathol. 2000;34(6):465-470.

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Abstract PDF: Actinomycosis causes a chronic suppurative infection most commonly involving the cervico-facial region, thorax, and the abdomen. Thoracic infection results from an aspiration of contaminated material from mouth or oropharynx. Actinomyces was known to have a predilection for the periphery of the lung and the endobronchial lesion is extremely rare. We report two cases of actinomycosis presenting as an endobronchial mass which arose in 53-year-old and 44-year-old women. The first case presented with cough, sputum, weight loss and had a history of pulmonary tuberculosis 24 years ago. Chest CT revealed a right lobe collapse simulating mass and suggested carcinoma. The second case presented with hemoptysis for 2 years. Chest CT revealed cystic bronchiectasis of both lungs and intracystic soft tissue mass in the anterior segment of the right upper lobe which suggested aspergilloma. The gross features of them were similar to those of aspergilloma. Characteristic sulphur granules consisting of a granular basophilic center surrounded by a radiating zone of eosinophilic, hyaline, club-shaped projection were histologically confirmed in both cases. Granulomas containing P. westermani eggs were present in the second case. Staphylococcus, true fungal organism, nocardia, and streptomyces shoud be distinguished by analysing their morphologic characteristics in the appropriate stains. Actinomycosis should be included in the differential diagnoses of an endobronchial mass.

Submandibular Soft Tissue Actinomycosis Diagnosed by Fine Needle Aspiration Cytology: A Case Report.: Ho Jung Lee, Dong Hoon Kim, Won Mi Lee, Eun Kyung Kim, Jong Eun Joo; Korean J Cytopathol. 2005;16(1):57-60.

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Abstract PDF: A patient with actinomyces infection of the submandibular soft tissue was diagnosed by fine needle aspiration cytology (FNAC). A 38-year-old woman presented with a right submandibular mass which slowly grew in size over one month. Clinically and radiologically, the lesion was considered as tuberculous lymphadenitis or cellulitis. The polymerase chain reaction for tuberculosis was done by aspirated specimen but the result was negative. The smears of aspiration cytology showed characteristic colonies(sulfur granules) of actinomyces in inflammatory background. After antibiotic therapy for eight months, the patient has been well, showing no detectable mass. This patient was simply and rapidly diagnosed by FNAC and can avoid unnecessary surgical biopsy.

Actinomycosis of the Penile Shaft Coexisting with Fibrous Pseudotumor of the Testis.: Eun Jung Cha, Kyu Yun Jang, Ho Sung Park, Jong Kwan Park, Chang Seop Lee, Myoung Ja Chung, Woo Sung Moon, Dong Geun Lee, Myoung Jae Kang; Korean J Pathol. 2008;42(1):50-53.

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Abstract PDF: Here, we present an uncommon case of the penile shaft actinomycosis with coexisting fibrous pseudotumors of the testis. A 37-year-old, circumcised man presented with one penile and eight scrotal masses. The penile mass having a healed surface ulceration was located at the right side of the penile shaft. It was relatively circumscribed without a fibrous capsule. The cut surface showed a yellow-brown color with central focal necrosis. The scrotal tumors were circumscribed, whorled, white masses 0.3-2.0 cm in diameters, and were attached to the tunica vaginalis and tunica albuginea. Microscopically, the penile mass showed active inflammatory changes containing actinomyces displaying characteristic sulfur granules. Testicular masses were fibrous pseudotumors composed of bland spindle and stellate cells lying in dense collagenous stroma. Actinomycosis of the penis has been reported to occur at the corona of the uncircumcised penis associated with pilonidal sinus. The present case was not associated with pilonidal sinus and, unusually, displayed co-existence with fibrous pseudotumors of the testis.

Actinomycosis of the Intrahepatic Bile Duct, Superimposed on Hepatolithiasis: A Case Report.: Ji Han Jung, Hyun Joo Choi, Jinyoung Yoo, Seok Jin Kang, Chang Suk Kang; Korean J Pathol. 2005;39(2):140-144.

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Abstract PDF: Actinomycosis is a chronic suppurative infection caused by Actinomyces, a filamentous, grampositive, anaerobic bacterium that is a normal inhabitant of the oral cavity and gastrointestinal tract. Actinomycosis of the biliary duct is very rare and the pathogenesis of this infection is poorly understood. We report here on a case of actinomycosis in the intrahepatic bile duct that was superimposed on hepatolithiasis. A 55-year-old woman presented with epigastric discomfort and episodic upper abdominal pain for 1 year. The radiologic findings revealed multiple hepatolithiasis and cholelithiasis. On performing left lateral segmentectomy of the liver, the markedly dilated intrahepatic bile duct contained several brown pigmented stones, and periductal chronic inflammation with fibrosis and proliferation of the bile ductules were observed. In addition to the intrahepatic stones, there were sulfur granules with neutrophilic infiltration and necrotic debris. The gram stain and methenamine silver stain revealed tangled filamentous and branching bacteria, which were consistent with Actinomyces. Acid-fast staining result was negative and no malignancy was detected.

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