Incidental histopathological diagnosis of tonsilar actinomycosis: A report of four cases.

Actinomycosis of the tonsils is uncommon even though the causative organisms are normal commensal of the oropharyngeal tract that may colonise the tonsillar crypts with resultant infection in apparently healthy individuals. Diagnosis is often incidental in tonsillectomy specimens sent to the pathology laboratory for varied diseases. This is a 10-year study of tonsillectomy specimens diagnosed with actinomycosis. Specimens were formalin-fixed and paraffin processed and stained with haematoxylin and eosin, gromott methenamine silver and periodic acid-Schiff. Four cases of tonsillar actinomycosis were diagnosed from a total of 772 tonsillectomy specimens. Histologically, characteristic oeosinophilic granules with peripheral radial protuberances surrounded by microabscesses were seen. Tonsillar actinomycosis is often an incidental diagnosis; however, a high index of suspicion should be entertained in patients with recurrent tonsillitis and/or tonsillar hypertrophy of unknown cause.

Primary Hepatic Actinomycosis Mimicking Neuroendocrine Tumor.

INTRODUCTION: The Actinomyces species is a fastidious, gram-positive, non-spore-forming bacteria that thrive in microareophilic and anaerobic conditions. Infection in the liver, an organ rarely affected by this pathogen, is presumed to be caused by hematogenous spread through the portal vein from a mucosal injury or other abdominal injury or a focus of infection. CASE DESCRIPTION:  A 60-year-old male patient has a mass lesion of 15 × 10 cm in the left lobe on computed tomography. A tru-cut biopsy was performed with USG, and fragmented tissue pieces were obtained. In histopathological examination, these samples were reported as tumors with neuroendocrine differentiation. The biopsy sample contains a large amount of tumor neighborhood, and tumoral area is quite small. And, therefore, a clear diagnosis could not be found. A mass lesion with mildly increased Ga 68 DOTATATE uptake was observed in the left lobe of the liver (SUVmax value 3.8) and was interpreted in favor of the primary neuroendocrine tumor of the liver. DISCUSSION: Actinomyces cases are very rare and their diagnosis is usually delayed due to its slow and insidious course, and lack of specific clinical and radiological findings. It is difficult to make a correct diagnosis even in microbiological examinations and biopsy materials obtained in the presence of imaging methods. It can mimic tumors of abdominopelvic structures. CONCLUSION: Actinomyces should be kept in mind in cases with liver masses accompanied by previous abdominal surgery, abdominal trauma, high fever, and leukocytosis.

Colloid cyst with hyphal-like structures: A rarity that mimics actinomycosis of athe third ventricle.

Colloid cysts are histologically well defined and consist of three main components, a capsule, with an underlying epithelial layer, and a mucinous heart. In our case, we present a 35-year-old female with acute deterioration of level of consciousness. An emergent CT scan showed a cystic lesion occluding the intraventricular foramen. The lesion was endoscopically excised through a transfrontal approach. Microscopic examination of the resected specimen revealed hyphal-like structures (HLS). This rare finding was first described by Dodds and Powers in 1977 and, in its microscopic nature, it mimics actinomyces of the third ventricle.

Lesiones perirradiculares persistentes: revisión narrativa / Persistent periradicular lesions: a narrative review

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)

The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)

Endobronchial Actinomycosis: A Case Report.

An extremely rare disease with a slow course, actinomycosis has a high mortality risk when not properly treated. Pulmonary actinomycosis is clinically and radiologically analogous with tuberculosis, foreign body aspiration, lung abscess, or lung cancer. Therefore, it often causes misdiagnosis or delay in diagnosis. A 65-year-old male patient, being followed up with the diagnosis of chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma, was admitted to our outpatient clinic with complaints of chronic cough. On chest CT, a cavitary lesion in the upper lobe of the right lung was observed. Sputum Acid Fast Bacilli (AFB) was negative for 3 consecutive times, fungal direct examination was negative, and there was no growth in mycobacterium culture and fungal culture. Flexible bronchoscopy revealed a raised, hard, white-colored lesion on the mucosa obliterating the apical and anterior segment bronchial entrance of the right lung upper lobe. A diagnosis of actinomycosis was made with sulfur granules seen in the pathology as a result of biopsy and lavage. Detection of sulfur granules in biopsy is essential for the diagnosis of actinomycosis, and a nearly complete response is usually obtained with long-term antibiotic treatment. Alternative methods such as surgical debridement should be considered in cases that do not respond to antibiotic treatment.

A 57-year-old man with painful ophthalmoplegia and cavernous sinus involvement: Why this is not Tolosa-Hunt syndrome.

Tolosa-Hunt syndrome (THS) is an idiopathic condition included in the differential diagnosis of painful ophthalmoplegia. Although this was once a common diagnosis, the increasing availability of tests reveals an alternative etiology in many cases. Exclusion of treatable disorders is important, because the prognosis may otherwise be poor. We here describe a patient who presented with painful ophthalmoplegia with an infiltrating lesion in the cavernous sinus. Initially suspected of THS, he had a fatal evolution, and postmortem evaluation revealed cervicocephalic actinomycosis. Actinomycosis diagnosis is often missed, and still represents a challenge to the clinician. We highlight pearls and pitfalls to establish a proper diagnosis to avoid missing a treatable condition in patients with suspected THS.

Esophageal Actinomycosis in an Immunocompetent Patient Mimicking Carcinoma: A Case Report.

Esophageal actinomycosis is a rare occurrence that presents a diagnostic challenge due to its vague clinical picture. The common symptoms include dysphagia, odynophagia and epigastric pain. These symptoms, although alarming, are usually non-specific. In this report, we describe an immunocompetent 38-year-old woman who presented with dysphagia and burning chest pain. Her initial examination and investigations suggested carcinoma of the oesophagus. On further evaluation and histopathology examination, she was diagnosed with esophageal actinomycosis and managed with antibiotics and symptomatic relief. She had significant improvement on follow up examination. The diagnosis of this condition in an immunocompetent patient can be confusing and requires a high degree of suspicion. Keywords: actinomycosis; carcinoma; case reports; esophagus.

Clinical and radiological characteristics of pulmonary actinomycosis mimicking lung malignancy.

INTRODUCTION: Pulmonary actinomycosis, clinically and radiologically, mimics abscess, tuberculosis, and lung malignancy, resulting in misdiagnosis or delay in diagnosis. In this study, we analyzed the clinicoradiological features of pulmonary actinomycosis, the presence of any differences between clinical prediagnosis and radiological diagnosis, and whether imaging modalities help distinguish pulmonary actinomycosis from lung cancer. METHODS: A total of 22 patients who had a histopathological diagnosis of actinomycosis in a tertiary health center participated in this study. Of these, 14 had positron-emission tomography/computed tomography. RESULTS: In all, 81.8% of the patients were males. The diagnostic procedures employed for the diagnosis of actinomycosis were surgery in 54.5% of patients, fiberoptic bronchoscopy in 36.4% of patients, and rigid bronchoscopy in 9.1% of patients. Radiological and clinical prediagnosis showed malignancy in 31.8 and 40.9% of patients, respectively. The mean of the maximum standardized uptake value was 6.33±3.6 on positron-emission tomography/computed tomography. Kappa compliance analysis revealed that clinical and radiological diagnoses were significantly compatible with each other and that radiological pre-diagnoses were not superior to clinical diagnoses (κ=0.701 and p<0.001). CONCLUSION: Pulmonary actinomycosis shows high metabolic uptake in positron-emission tomography/computed tomography, and this may mislead clinicians for a diagnosis of malignancy. Our results suggest that positron-emission tomography/computed tomography does not help distinguish pulmonary actinomycosis from lung malignancy and does not provide a clear diagnostic benefit to the clinician, so pathological diagnosis is necessary.

Tonsillar actinomycosis that mimics tonsillar neoplasm.

Actinomycosis is a chronic suppurative infection that can develop almost anywhere in the body. Cervicofacial actinomycosis is the most common form of the disease. We report a case of tonsillar actinomycosis that causes massive, asymmetric enlargement of tonsil and mimics the neoplasia. The most common cause of asymmetric tonsil hypertrophy is tonsillar squamous cell carcinoma and lymphomas. Tonsillar actinomycosis is a rare entity that should be kept in mind, if cases cannot be clarified with clinical and laboratory findings, when radiological findings are suspicious about malignancy.

Pulmonary actinomycosis: cytomorphological features.

Pulmonary actinomycosis is an uncommon infectious disease. Although the gold standard for diagnosis is histological examination with bacterial culture of lung tissue, cytology samples offer a fast and low-cost alternate diagnostic procedure. The cytology literature on this topic is limited to mostly case reports. Therefore, the aim of this study was to review cytological material in a series of patients with a diagnosis of pulmonary actinomycosis to characterize the main cytomorphological findings.  Different cytological respiratory samples including sputum smears, bronchoalveolar lavages (BALs), transthoracic or endobronchial fine needle aspiration cytology (FNAC) and cell block preparations were used for retrospective examination. For all cases patient age, gender, symptoms, and radiological chest findings were recorded. A total of 26 cytological respiratory samples (14 sputum smears, 9 FNAC, two BALs) including direct smears and 6 cell blocks from 9 patients were examined. In sputum smears the most remarkable findings were the presence of dark cotton ball masses with projections like spider legs and/or mouse tails (75% of the samples). Sulfur granules were observed in 4 (40%) of the sputum smears and within FNAC cases. Various respiratory cytology samples including sputum smears, FNAC and BALs can reveal cytomorphological findings diagnostic of pulmonary actinomycosis. Characteristic cytological findings compatible with a diagnosis of this infection include cotton ball masses and less frequently sulfur granules.

Unusual presentations of actinomycosis: a case series and literature review.

INTRODUCTION: To review unusual actinomycosis cases that appeared as a diagnostic and therapeutic challenge at our institution and to present a literature review on the usual clinical presentations. METHODOLOGY: This retrospective review included all patients hospitalized for actinomycosis in a 10-year period at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb, Croatia. RESULTS: A total of 15 patients were hospitalized during the observed period, 9 (60%) females and 6 (40%) males. The localizations of actinomycosis were: pelvis (5), lungs (3), blood stream (2), colon (1), penis (1), stomach (1), skin (1), cervicofacial region (1). We present four unusual cases: subcutaneous actinomycotic abscess, actinomycosis of the stomach with underlying non-Hodgkin lymphoma, sepsis due to Actinomyces neslundii originated from chronic asymptomatic periapical tooth abscesses and actinomycosis of the distal part of the penile shaft. CONCLUSIONS: Actinomycosis was a very rare clinical problem in our clinical practice (0.032% of all hospitalizations and 0.0034% of all outpatients) but among those cases classical clinical presentations were also very rare.

Abdominal wall actinomycotic mycetoma involving the bowel: a rare entity.

Actinomycotic mycetoma is a disease of the tropical region and usually presents as a chronic, suppurative and deforming granulomatous infection. We present an unusual case of actinomycotic mycetoma of the abdominal wall that was found to infiltrate into the bowel. A 51 year-old man presented with pain and swelling in the left flank of 2-year duration. Even after comprehensive preoperative evaluation with advanced radiological imaging, biochemistry and pathology, the diagnosis could not be arrived at. Histopathological examination of the excised specimen after the surgery guided to the diagnosis of actinomycotic mycetoma, which entirely changed the management in the postoperative period. We propose that mycetoma should be kept as a possible differential diagnosis for anterior abdominal wall swelling in the indicated clinical setting and the investigations be done keeping the same in mind. Otherwise, a lot of valuable time may be lost allowing the disease to progress further.

Pathologist-performed palpation-guided fine needle aspiration cytology of lingual actinomycosis: A case report and review of literature.

"Lingual actinomycosis" is an uncommon, suppurative inflammation of lingual mucosa, caused by Actinomyces. Infectious oral lesions can mimic benign or malignant neoplasms and fine needle aspiration cytology (FNAC) is a simple, minimally invasive procedure for the assessment of patients with such lesions. Here, we describe the case of a 28-year old patient presented with an asymptomatic, submucosal nodular mass of the tongue. Then, FNAC was performed by an experienced fine needle aspiration (FNA) pathologist (* ) in our pathology department and the lesion diagnosed with actinomycosis. We also report a detailed review of cases in the literature, with clinical findings.

Acute actinomycotic brain abscess in a patient with rheumatoid arthritis.

An autopsy case of acute actinomycotic brain abscess involving a patient with rheumatoid arthritis (RA) is reported. The patient was a 72-year-old man with a seven-year history of RA and pulmonary complications, who acutely developed dysarthria and dysphagia three days before death. Autopsy revealed a fresh, non-encapsulated abscess in the "late cerebritis" stage, measuring 2 cm in diameter, in the white matter of the right parietal lobe. A small number of tiny "sulfur granules" consisting of numerous filamentous bacilli were found within the abscess. The abscess had ruptured to the lateral ventricle and elicited ventriculitis, and mild acute purulent leptomeningitis was also observed. The lung showed chronic interstitial pneumonia/pulmonary fibrosis with bronchiectasis and emphysema, and large sulfur granules were found in the lumens of a few bronchi. Less than 5% of patients with actinomycotic infection develop central nervous system lesions, and actinomycotic brain abscesses make up only 0.6% of all brain abscesses. Actinomycotic brain abscesses usually pursue a protracted clinical course, and well-formed pyogenic membranes are commonly observed. The present case is exceptional in that the very early stage of the cerebral abscess formation was pathologically captured.

Actinomicosis primaria de la pared abdominal / No disponible

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A very rare case of possible actinomycosis of the mandible from the Middle Ages.

OBJECTIVE: Documented cases of actinomycosis in archaeological skeletons are very rare, especially from Central Europe. Our contribution will help facilitate the differential diagnosis of this disease for other paleopathologists. MATERIAL: This paper describes a pathological finding of the skeleton of a 40-year-old male from a burial ground in Sady-Spitálky (Czech Republic) dated to the 10th-12th century. METHODS: The affected skeleton was evaluated as a probable case of actinomycosis on the basis of a detailed macroscopic, X-ray and histological examination. The osteolytic foci examined were compared with similar changes caused by tuberculosis, syphilis and mycoses. RESULTS: The character and location of the defect on the mandible is indicative of organ actinomycosis and is also reflected by the lytic lesion observed on a lumbar vertebra. CONCLUSIONS: The described case can be considered one of the very rare paleopathological findings of possible actinomycosis in humans in Central Europe. SIGNIFICANCE: Good evidence of bone actinomycosis findings may be beneficial for further paleopathological and epidemiological studies, especially for research focused on the diachronic development of actinomycosis in Europe. In doing so, all available factors, such as hygiene habits, nutrition, social structure and overall health of the population that could be causally related to its origin, course and treatment, can be taken into account. LIMITATIONS: The mandible of the studied individual was damaged, especially in the area affected by the lesion, so the paleopathological analysis was difficult to perform. SUGGESTION FOR THE FUTURE RESEARCH: In future, actinomycosis in this skeleton may be confirmed by bio-molecular analysis.

A 78-Year-Old Man With Recurrent Hemoptysis and Persistent Pulmonary Nodule.

CASE PRESENTATION: A 78-year-old Chinese man presented in March 2019 with a 2-day history of small-volume hemoptysis. He did not report any associated chronic cough, sputum production, epistaxis, night sweats, unintentional weight loss, or fever. He was an ex-smoker of 10 pack years. His medical history was significant for ischemic heart disease on aspirin, as well as hospitalizations in 2016 and 2017 for hemoptysis. The patient's evaluation for hemoptysis was only notable for a right middle lobe nodule on chest CT imaging and Klebsiella pneumoniae on sputum cultures, for which he was treated with antibiotics.