Clinicopathological spectrum of cervicofacial actinomycosis

Introduction and Aim: Cervicofacial actinomycosis is a rare chronic granulomatous disease caused by Actinomyces and is the commonest subtype of actinomycosis. Due to the similarities in clinical presentation, cervicofacial actinomycosis is almost always suspected as malignancy or tuberculosis. Histopathological evaluation is crucial in diagnosis and management of these cases. The aim of the study was to evaluate the clinicopathological features of cervicofacial actinomycosis in the biopsy specimens.   Methodology: This is a retrospective cross sectional observational study of 17 years duration. All cases of cervicofacial actinomycosis diagnosed on biopsy specimens were analyzed. Clinical presentations and histomorphological features were evaluated on hematoxylin and eosin-stained slides with confirmation of organism on special stains.   Results:  Out of 36 diagnosed cases of actinomycosis during the study period, we evaluated 16 cases (44.4%) of cervicofacial actinomycosis. Mean age of presentation was 38 years. Male to female ratio was 1:0.9. The anatomical sites of eight (50%) were in the oral cavity, six (37.5%) on the face and two (12.5%) in the neck. Two cases (12.5%) had sinuses discharging sulphur granules. Six cases (37.5%) were clinically suspected as malignant and among them two cases (12.5%) also had differential diagnosis of tuberculosis. All cases on histomorphology showed sulphur granules consisting of basophilic filamentous bacterial colonies with Splendore Hoeppli phenomenon and mixed inflammation. On special stains, the bacterial colonies were Gram, PAS and GMS stain positive, and acid fast negative.   Conclusion: Cervicofacial actinomycosis are uncommon. Their presentation can mimic carcinoma or tuberculosis. Consistent histomorphological features can direct towards identification of organisms by special stains for confirmation of diagnosis.