Actinomycosis in fine needle aspiration cytology

Abstract

Four cases of actinomycosis were diagnosed by fine needle aspiration (FNA) cytology and eight more cases were detected during a review of FNA smears reported as inflammatory. The age of these 12 cases ranged from 20 to 61 years with a median of 35 years. The male to female ratio was 3:1. The common regions of involvement were cervicofacial in seven cases (58.3%), thoracic in three (25.0%) and abdominal in two (16.7%). Four of the seven cervicofacial cases presented with intra-oral masses; the thoracic lesions were pulmonary in location, and the abdominal lesions presented as bowel masses. The possibility of actinomycosis was not considered clinically in any case. The main reason for missed cytodiagnosis in two thirds of the cases appeared to be observer error. It is suggested that when the aspiration smear from a mass is found to be an inflammatory exudate rich in neutrophils, special efforts must be made to look for this microorganism.

Pulmonary actinomycosis

“…In these few patients, if the diagnosis is suspected pre-operatively, the aim should be to conserve as much of the lung as possible. Since the gross appearance of the pulmonary actinomycosis intraoperatively is indistinguishable from that of carcinoma, a frozen section, on a wedge resection or surgical trucut biopsy, may help in deciding the extent of the resection [59,60]. It is still important to alert the pathologist of the suspected diagnosis, as special stains may have to be used to look for the organism [59].…”

“…In general, an attempt at establishing diagnosis by percutaneous biopsy with fine needle aspiration or core biopsy is now made before "blind" thoracotomy [58]. When guided by ultrasound or CT, this has proven a simple, safe and effective diagnostic technique and reduced the number of unnecessary resections [59][60][61]. Sometimes reassurance that the patient does not have a malignancy can only be provided by open resection.…”

Pulmonary actinomycosis: a case undergoing resection through video-assisted thoracic surgery (VATS)

“…A reliable diagnosis of this pathogen still requires histological or microbiological examinations. Biopsy through fiberoptic bronchoscopy can be used in patients with endobronchial actinomycosis (Ariel et al, 1991), and the ultrasound or CT guided biopsy used for the diagnosis of patients with peripheral lung lesions (Das, 1994).…”

Tratamento da actinomicose pulmonar com levofloxacina

“…In case of fistula, the presence of granules in the secretions is the key to diagnosis. (6) As in the case presented here, TNAB can be important to allow collection in media that are appropriate for culture examination.…”