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

Granulomatous Mycosis Fungoides: A case report.: Kyung Sin Lee, Young Oak Kim, Kee Suck Suh, Sang Tae Kim, Man Ha Huh; Korean J Pathol. 1995;29(5):694-697.

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Abstract: Granulomatous mycosis fungoides is an extremely rare and unusual histologic variant of mycosis fungoides. This form is clinically characterized by spontaneous resolution of ulcerated nodular lesions into poikiloderma. Histologically, a strong granulomatous component can obscure the underlying cutaneous lymphoma, which is frequently mistaken for non-neoplastic dermatitides or cutaneous sarcoidosis. We report a case of granulomatous mycosis fungoides occurring on the left cheek of 34-year-old man confirmed histologically with an aid of immunohistochemistry and clinical course (immediate response to PROMACE-CYTOBAM chemotherapy), with emphasis on differential diagnosis, along with a review of literature. This is the first documented report in the Korean literature.

Chromomycosis of the Nasolacrimal Duct: Report of a case.: So Dug Lim, Ji Eun Kim, Kyu Rae Kim; Korean J Pathol. 1996;30(4):358-360.

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Abstract PDF: Chromomycosis is a chronic cutaneous fungal infection characterized by the presence of dark brown parasitic forms of fungi in biopsied tissues. It is usually resulted from the entry of the causative organism through a minor trauma, and therefore, most lesions are found on the exposed part of the body, such as limbs or face, and occurrence on the nasolacrimal duct is extremely rare. We report a case of chromomycosis of the right nasolacrimal duct, which was presented with clinical symptoms of nasolacrimal duct obstruction. The patient was a 40 year-old male who had had minor injuries on his left eye twice by paper and branches of the tree two months prior to epiphora in right eye. On dacryocystorhinostomy, right nasolacrimal duct was obstructed by pinkish brown mucoid ball. Microscopically, the mucoid ball revealed eosinophilic, amorphous, necrotic materials admixed with brown pigmented fungi. The organism showed characteristic dark brown, round, thick-walled, often septated, sclerotic bodies and brown pigmented long bead-like hyphae. The adjacent mucosa shows marked chronic nonspecific inflammation with fibrosis.

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.

A Case Report of Cutaneous Coccidioidomycosis.: Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Hai Jin Park, Yee Gyung Kwak, Je G Chi; Korean J Pathol. 2008;42(4):223-225.

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Abstract PDF: Coccidioidomycosis, which results from inhaling the spores of Coccidioides species, is endemic in the southwestern United States. The primary infection site is the lung, and dissemination of the disease can occur. We report a case of cutaneous coccidioidomycosis in a 79-year-old Korean woman who presented with purpura on both lower extremities, but no pulmonary symptoms and no history of visiting an endemic area. Microscopically, skin biopsy showed multiple aggregates of granulomas in the dermis. Numerous multinucleated giant cells were associated with the granulomas. Mature and immature fungal spherules, which were 20 to 30 micrometer in diameter, were present inside and outside the multinucleated giant cells.

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.

Chromomycosis of the Skin: A case report.: Tae Sook Kim, Kye Yong Song, Je G Chi; Korean J Pathol. 1993;27(5):531-534.

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Abstract PDF: Cutaneous chromomycosis is a slow growing verrucous skin infection caused by five species, identified as Philadophara verruscosa, Fonsecaea dermatitidis, Fonsecaea pedrosoi, Fonsecaea compactum, Cladosporium, carionii. We report a case of chromomycosis of the skin causing by Cladosporium genus, in view of its rarity and unique light microscopic and ultrastructural features. This 65-year-old female had suffered from eczematous and lichenified skin lesion for the last two years since she burned her dorsum of the left hand by boiling oil. The lesion was slowly progressed, and ended up to the brownish hardening of the skin covered with crusts. Skin punch biopsy was done. Histologically, the sections revealed typical features of chronic granulomatous inflammation along with the heavy infiltration of the lymphocytes, plasma cells and histiocytes. Pseudocarcinomatous downgrowth of the epidermis and microabscesses in the upper dermis were also found. Numerous thick walled fungal organisms were noted within the giant cells and freely in the dermis, which were positive ant PAS stain, and diastase resistant. Thick mucous capsule is not observed. The organisms showed very faint yellowish walls with a few buddings and a few short elongated hyphae were also noted. Ultrastructurally, the fungus wall was multilayered and inner organelles were sparse. There is no evidence of systemic involvement, especially brain.

Original Articles

A Pathologic Study of Lymphoproliferative Disorders of the Skin.: Yee Jeong Kim, Kwang Gil Lee, Soo Il Chun, Yun Woong Ko; Korean J Pathol. 1991;25(6):551-562.

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Abstract PDF: Forty eight skin biopsies obtained from 24 patients were reviewed, and clinical, histological and immunohistochemical findings were analyzed. Results obtained are as follows: 1) Skin manifestation was plaque, erythroderma, scale and hyperpigmentation in mycosis fungoides, and subcutaneous nodule, mass and ulcerated patch in cutaneous lymphoma. The skin of lymphomatoid papulosis revealed hemorrhagic ulcerated and erythematous papules which healed spontaneously. 2) Histologically, mycosis fungoides showed epidermotropism in most cases. Pautrier's micro-abscesses were present in one-fourth of the cases. Malignant lymphoma was different in histology from mycosis fungoides. As compared with mycosis fungoides, it showed less frequent epidermotropism, more compact and diffuse infiltration of atypical lymphocytes, more often association with ulcer and necrosis, and more frequent mitotic figures. Lymphomatoid papulosis showed striking hemorrhage and edema of the papillary dermis. 3) Based on the results of immunohistochemical study, mycosis fungoides and lymphomatoid papulosis were considered as a T cell proliferative disorder of the skin. According to these findings, lymphoproliferative disorders of the skin occurred predominantly in the elderly and males. Clinical and histopathologic findings overlapped and were similar each other. It was difficult to make a definite diagnosis in early lesions, and a sequential follow up biopsy was required. It is concluded that strict criteria such as marked atypia and clustering of atypical cells are necessary for a histologic diagnosis of malignant lymphoproliferative disorder of the skin.

Deep-seated Fungal Infections in Biopsy Specimens.: Kyung Ae Yoon, Je G Chi; Korean J Pathol. 1990;24(4):349-357.

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Abstract PDF: A total of 197 cases of fungal infections in biopsy specimens obtained from the pathology file of the Department of Pathology, Seoul National University Hospital, for a period of 28 years from 1960 to 1987 were studied by histopathologic investigations with analysis of clinical records. The following results are obtained; 1) While most fungal infections increased in number, annual relative frequency of them were between 0.1% and 0.2%. 2) Among 197 cases of fungal infections, deep-seated mycosis was 175 cases (88.8%). Aspergillosis was the most common mycosis, accounting for 29.4 percent. 3) The age and sex distribution of fungal infection was even throughout the ages, but it was more common in age group over fifty, and the male was more frequently affected than the female. 4) Aspergillosis was encountered in 58 cases (29.4%) and the preferred localization was the lung. The candidiasis was seen in 48 cases (24.4%) and the preferred localization of cryptococcosis was lymph node and skin.

Case Report

Phycomycosis Involving Ankle Joint: Report of a case.: Eui U Park, Jung Ran Kim, Je G Chi; Korean J Pathol. 1988;22(4):495-499.

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Abstract PDF: Phycomycosis is an uncommon opportunistic fungal infection, involving several organs, such as brain, lungs, gastrointestinal tract and skin. Invasion of joint cavity by phycomycetes, however, has never been reported. We report a case of 33-year-old male who had had prehallux with congenital equinovarus and underwent correction operation on the right ankle joint. There after, joint pain and edema had developed on that site. He received reoperation and underwent excisional biopsy from there. Operation showed hypertrophied yellowish synovium. On microscopic examination, the tissue showed several foci of fibrinoid necrosis and suppurative and granulomatuous inflammation. Periodic acid Schiff stain demonstrated broad. Aseptate hyphae that were wrinkled and folded.

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