Actinomycosis of the female genital tract.

Four cases of actinomycosis involving the uterus and adnexal structures are reported. In 2 cases the infection was transmitted from a ruptured appendix. Ascending actinomycosis involving the endometrium and resulting in adnexal abscesses was associated with the use of an IUD in 2 patients. This infection should be suspected in any patient who develops a pelvic abscess with an IUD in place. Culture and histologic examination of tissue removed with the IUD may be a means of early diagnosis. The nature of these infections became apparent only after serious complications developed. Each patient required several surgical procedures. The diagnosis remained unsuspected until repeated laboratory examinations detected the fungus. The difficulty encountered identifying Actinomyces israeli indicates the infection is often undetected. Gallium scans were helpful in localizing occult abscesses in 2 patients.

PIP: 4 cases of actinomycosis, treated at the University of Virginia Hospital, involved the uterus and adnexal structures. 2 cases were the result of a transferred infection from a ruptured appendix. Ascending actinomycosis involved the endometrium and resulted in adnexal abcesses for 2 patients in which infection was associated with the use of an IUD. A means of early diagnosis might be through examination of tissue removed with an IUD. The nature of these infections becomes apparent only after serious complications develop. Patients required several surgical procedures. The diagnosis may remain undetected through repeated examination in the laboratory. This difficulty in detecting Actinomyces israeli indicates that the infection may often be undetected. Gallium scans were helpful in localizing occult abscesses i n 2 patients.

Progesterone production by an ovarian granulosa cell carcinoma.

A patient with a progesterone-producing granulosa cell carcinoma is the basis of this report. Seven years after initial surgical therapy pelvic masses were palpated. At laparotomy the recurrence of tumor was confirmed, and many nonresectable metastases were discovered on the surface of the liver and on the mesentery of the bowel. An exceedingly high plasma progesterone level of 6270 pg/ml was obtained in the postoperative period. During 12 months of single agent chemotherapy with melphalan, serial plasma progesterone assays declined to 310 pg/ml. Complete tumor regression was subsequently confirmed by laparoscopy. Evaluation of progesterone levels in patients with granulosa cell tumors is recommended to determine the incidence of this finding and to further assess its value in following response to therapy.