Advances in Cytology & Pathology
Case Report Open Access
Actinomyces abscess mimicking mandibular bone
cyst
Abstract Volume 3 Issue 5 - 2018
A radiolucent, well demarcated right mandibular bone lesion with a clinical
Nasuhi Engin Aydin
presumptive diagnosis of solitary bone cyst was surgically excised in a 60year old Department of Pathology, Ataturk Hospital, Turkey
woman. The histopathologic examination revealed Actinomyces colonies surrounded
by chronic granulation tissue. This presentation is unique due to its completely Correspondence: Naushi Engin Aydin, Department of
encapsulated abscess formation rather than the more common fistula formation seen Pathology, Ataturk Hosiptal Karabaglar, Izmir, Turkey- 35000, Tel
in Actinomyces lesions. +90(546)6157058, Email
Keywords: actinomyces, histopathology, mandibular, abscess Received: December 20, 2018 | Published: December 28,
2018
Introduction
Actinomycosis is an infection with the anaerobic gram-positive
filamentous bacterium Actinomyces, which may cause cervicofacial
infection, and occasionally pulmonary, gastrointestinal, or
disseminated infections.1,2 It is uncommon, but is still an important
cause of morbidity. Its clinical presentation is usually indolent and
chronic as slow growing masses that may evolve into fistulae, and for
that reason are frequently underdiagnosed. Actinomyces spp is often
disregarded clinically and is classified as a colonizing microorganisms
since they are commensal in human body.
Case presentation
A 60 year old woman complaining of intermittent pain in the right
jaw region for a few months was seen at the outpatient department.
The patient’s medical history was unremarkable without any health Figure 1 Huge groups of microrganisms among necrotic bone spicules and
chronic inflammatory tissue elements, (Hematoxylin eosinx200).
problem. Physical examination and CBC was unremarkable but a plain
radiograph of the jaw region showed a 2cm well delineated lucency
suggestive of a simple bone cyst. A diagnostic and therapeutic surgical
excision was made by curettage of the lesion. There was no cyst fluid,
but soft friable tissue fragments with yellowish foci were noticed in
the mandibular bone during the procedure. Specimens received at
the pathology laboratory measured soft, light brown tissue fragments
1.5x1x1cm in aggregate with yellowish areas. Histopathologic
examination after paraffin embedding all the tissues received revealed
a chronic inflammatory granulation tissue and huge, prominent
colonies of a filamentous microorganism within small bone fragments
(Figure 1) (Figure 2). The filamentous microorganism granules were
Gram’s stain and Grocott’s methenamine silver (GMS) positive
(Figure 3) besides yielding a periodic acid Schiff positive reaction
following diastase digestion (Figure 4). A diagnosis of Actinomyces
abscess was made. The aerobic microbiological cultures of the lesion
Figure 2 Higher power view of the microorganism croup showing a dense
was negative for any bacteria.
structure, ((Hematoxylin eosinx400).
Submit Manuscript | http://medcraveonline.com Adv Cytol Pathol. 2018;3(5):126‒127. 126
© 2018 Aydin. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits
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Copyright:
Actinomyces abscess mimicking mandibular bone cyst ©2018 Aydin 127
and Propionibacterium.1,2 Physicians must be aware of typical clinical
presentations (such as cervicofacial actinomycosis following dental
focus of infection, pelvic actinomycosis in women with an intrauterine
device, and pulmonary actinomycosis in smokers with poor dental
hygiene), but also that actinomycosis may mimic neoplastic processes
in various anatomical sites.1–3 In the human oropharynx, Actinomyces
species are particularly prevalent within gingival crevices, tonsillar
crypts, periodontal pockets and dental plaques, as well as on
carious teeth. Consequently, actinomycosis is mainly considered an
endogenous infection that is triggered by a mucosal lesion.4,5 However,
the pathogenesis of invasive disease following oral mucosal breach is
not clear. Cervicofacial actinomycosis is the most frequent clinical
form that may be associated with large abscesses and/or mandibular
osteomyelitis with or without sinus tract. Cervicofacial actinomycosis
may lead to distant organ dissemination, including brain, lungs, and
Figure 3 Silver impregnation of the sections clearly demonstrate the digestive tract so early diagnosis and treatment with penicillin group
filamentous structure of the microorganism colony (GMSx400). of antibiotics essential in which high-dose penicillin is the cornerstone
of therapy. The risk of developing penicillin resistance appears to be
minimal.
Acknowledgments
None.
Conflicts of interest
The authors declare that they have no conflicts of interest.
References
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Citation: Aydin NE. Actinomyces abscess mimicking mandibular bone cyst. Adv Cytol Pathol. 2018;3(5):126‒127. DOI: 10.15406/acp.2018.03.00068
