Preoperative diagnosis of pelvic actinomycosis by clinical cytology

Abstract

Background: The purpose of this work was to investigate whether clinical cytology could be useful in the preoperative diagnosis of pelvic actinomycosis.

Methods: This study involved the prospective collection of samples derived from the endometrium and the uterine cervix, and retrospective data analysis. Nine patients with clinically diagnosed pelvic actinomycosis were enrolled. The clinical and hematological characteristics of patients were recorded, and detection of actinomyces was performed by cytology, pathology, and bacteriological culture of samples and by imprint intrauterine contraceptive device (IUD) cytology.

Results: The detection rate of actinomyces was 77.7% by combined cervical and endometrial cytology, 50.0% by pathology, and 11.1% by bacterial culture.

Conclusion: The higher detection rate of actinomyces by cytology than by pathology or bacteriology suggests that careful cytological examination may be clinically useful in the preoperative diagnosis of pelvic actinomycosis.

Keywords: actinomycosis; cytology; intrauterine contraceptive device; pathology; pelvic inflammatory disease.

Figure 1

(A) Cytology of the endometrium, with basophilic granules of actinomyces seen with an inflammatory background (Papanicolaou stain, object lens magnification 10×). (B) Magnified image of (A) (Papanicolaou stain, 40×). Thin filamentous mycelia are seen spreading outwards. (C) Imprint cytology of intrauterine contraceptive device. Many actinomyces colonies are seen within severe inflammatory background (Papanicolaou stain, 10×). (D) Gomori methenamine-silver stain of (C) showing presence of numerous blackish fine mycelia (40×).

Figure 2

Brush cytology of granular discharge containing many actinomyces colonies (A) (Papanicolaou stain, object lens magnification 4×). (B) Magnified image of (A) (Papanicolaou stain, 40×) showing actinomyces strangles with abundant mycelia radiating outwards. (C) Gomori methenamine silver stain of (B) showing presence of blackish thin filamentous mycelia radiating outwards (40×).

Figure 3

Hematoxylin and eosin stain of sample derived from right adnexal abscess. (A) Basophilic actinomyces colonies are seen in the central hematoxylin-stained area and eosinophilic colonies are seen in the periphery (sulfur granules). Splendore-Hoeppli materials are also seen in the outermost layer (object lens magnification 20×). (B) Gomori methenamine silver stain of (A) showing abundant mycelia radiating outwards (20×).