Primary actinomycosis of breast—A diagnosis on cytology

Abstract

Primary actinomycosis of breast is a rare disease with only a few cases reported in the literature. We present a case of a 25-year-old lactating woman with primary actinomycosis of breast which was diagnosed on cytology. The patient presented with lump in left breast with dull aching pain. Fine-needle aspiration cytology smears showed acute suppurative inflammation with presence of fluffy basophilic colonies on Hematoxylin and Eosin staining and branched, Gram positive filamentous bacilli on Gram staining. The bacilli were non-acid fast with 1% Zeihl Neelsen stain. A diagnosis of actinomycosis was suggested on cytology. Histopathological examination revealed an abscess with few Gram positive basophilic granules surrounded by eosinophilic Splendore-Hoeppli material thus confirming the diagnosis of actinomycosis. Meticulous search for microorganisms with the aid of special stains should be done on cytology smears before labeling an inflammatory lesion as nonspecific. Diagn. Cytopathol. 2016;44:693-695. © 2016 Wiley Periodicals, Inc.

Actinomycosis of the breast and lungs

“…[1][2][3]5 Actinomycosis causing breast abscess is rare in men [8][9][10][11][12] as well as in women. 4,[12][13][14][15][16][17][18][19][20][21][22][23] As a cause of miliary lung lesions [24][25][26][27][28] or of spontaneous sinus tracts exiting the sternum, 29,30 it is even rarer. Yet, all three of these manifestations were evident simultaneously in our patient.…”

The cytopathology of Actinomyces, Nocardia, and their mimickers

“…Culture can be especially helpful in corroborating cytology. However, Nocardia may require extended incubation periods before successful growth in culture, and some Actinomyces are obligate anaerobes, which are not recovered in routine aerobic respiratory cultures …”

“…Nocardial and actinomycotic infections diagnosed via FNA are relatively rare, but FNA has great utility in this setting as these infections often clinically and radiographically mimic malignancy . Case reports describing the utility of FNA for identifying these filamentous bacteria include the following sites of infection: lung, cerebrum, perirectal soft tissue, common bile duct, parotid, neck, eye, breast, vulva, and skin/subcutaneous tissue . Pulmonary lesions, a common site for both Nocardia and Actinomyces infections, are accessible via endobronchial ultrasound guided (EBUS) FNA.…”

“…Filamentous bacteria may not be observed with routine staining as they have a very light staining quality and are thin in width . The presence of inflammation and/or acellular material that are commonly associated with Nocardia and Actinomyces should prompt further investigation with ancillary histochemical stains.…”

“…With either group of bacteria, the potential for serious infections exists, and these microorganisms often demonstrate overlap in their clinical presentations . Both can present as infections within the lung, soft tissue, bone, joint, or central nervous system (CNS) as well as a number of less frequent anatomic sites including the nipple and the skin . Additionally, both are capable of systemic dissemination, typically through hematogenous routes …”