Cytopathology of Hepatobiliary-Related Actinomycosis

Abstract

Background: The clinical diagnosis of hepatobiliary-related actinomycosis can be challenging owing to its rarity and variable presentation. Moreover, actinomycotic pseudotumors may mimic malignancy and result in unnecessary surgical resection. Herein, we present the clinical and cytopathological features of 3 cases with hepatobiliary-related actinomycosis. Cases: The first patient was a 73-year-old man who presented with an exophytic liver lesion. The second patient was a 78-year-old woman who presented with a biliary stricture. The third patient was an 88-year-old woman with a right flank mass extending to the liver. The aspirate smears in these 3 cases demonstrated ‘cotton ball' clusters of filamentous microorganisms and abscesses. The cell blocks of 2 of the patients showed sulfur granules with peripheral filamentous microorganisms positive with a Gram stain but negative with an acid fast stain, consistent with Actinomyces species. All patients were elderly and shared a past surgical history of laparoscopic cholecystectomy. Conclusion: These casesdemonstrate the complementary role of cytology in the diagnosis of hepatobiliary actinomycosis. A cytologic diagnosis of actinomycosis is minimally invasive and quick. It can prompt proper culture medium selection and avoid unnecessary or extensive surgery. Based on our experience, laparoscopic cholecystectomy may be a precipitating factor for the subsequent development of hepatobiliary-related actinomycosis.

A 60-Year Literature Review on Hepatic Actinomycosis

“…In particular, remote surgical abdominal or pelvic procedures were described in 32.3% of patients [3,. Recent abdominal or pelvic surgery (≤1 year) was reported in 25 cases including intrauterine contraceptive device (IUCD) removal (n = 12) [42][43][44][45][46][47][48][49][50][51][52][53], appendectomy (n = 3) [54][55][56], gastrectomy (n = 2) [57, present case], cholecystectomy (n = 3) [34,37,58], total pancreatectomy [59], stenting bile and pancreas (n = 2) [29,60], perforated peptic ulcer (n = 1) [61], and drainage of a rectal abscess (n = 1) [62]. Other predisposing conditions included diabetes mellitus, alcohol abuse, dental caries or abscesses, the use of IUCD, viral hepatitis, chololithiasis and cholangitis, the use of illicit drugs, and end-stage renal disease-in hemodialysis.…”

Splendore‐Hoeppli phenomenon in a fine needle aspirate of cervicofacial actinomycosis

“…The SHP has been described in cell block sections and rarely also in smears from bronchial and bile duct brushings or washings, fine needle aspirates from subcutaneous breast, lung and liver masses, in patients suffering from botryomycosis, actinomycosis, actinomycetoma and eumycetoma, sporotrichosis and blastomycosis…”

“…Infections characterized by the presence of "granules" may be surrounded by an accumulation of brightly eosinophilic material. This is referred to as the Splendore-Hoeppli phenomenon (SHP), and can The SHP has been described in cell block sections and rarely also in smears 9 from bronchial and bile duct brushings or washings, fine needle aspirates from subcutaneous breast, lung and liver masses, in patients suffering from botryomycosis, 10 actinomycosis, 11,12 actinomycetoma 13,14 and eumycetoma, 14 sporotrichosis 15 and blastomycosis. 16 The importance of the identification of the SHP is primarily to draw attention to the eliciting infectious agent, 9 and, in correlation with clinical and microbiology studies, lead to the appropriate diagnosis and treatment.…”