REVIEW

Pseudoactinomycotic radiate granules of the gynaecological tract: review of a diagnostic pitfall

B Pritt, S L Mount, K Cooper, H Blaszyk

Department of Pathology, University of Vermont College of Medicine, Burlington, VT 05405, USA

Correspondence to:
Correspondence to:
Dr H Blaszyk
Department of Pathology, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, USA; hagen.blaszyk{at}vtmednet.org

The filamentous bacterium actinomyces can cause serious gynaecological tract infections, including pelvic inflammatory disease (PID) and tubo-ovarian abscess. Thus, definitive diagnosis of actinomycotic granules (AMGs) in gynaecological specimens is clinically important. Non-infectious pseudoactinomycotic radiate granules (PAMRAGs) can mimic the microscopic appearance of AMGs. PAMRAGs may be more common than actinomycotic infections in specimens from patients using intrauterine devices and may be seen in patients with PID. Although the composition and aetiology of PAMRAGs is unclear and variable, a panel of histochemical stains can aid in diagnosis. On haematoxylin and eosin (H&E) stained sections, AMGs show as distinct granules with basophilic peripheral radiating filaments and a dense central eosinophilic core, whereas H&E stained sections of PAMRAGs feature refractile granules with irregular club-like peripheral projections and no central dense core. The filaments of AMGs are Gram positive on Brown and Brenn (B&B) stain and are highlighted with Gomori methenamine silver stain (GMS). They stain negatively with a modified acid fast bacillus (AFB) stain, aiding in the distinction of actinomyces from nocardia. PAMRAGs show negative or non-specific staining with B&B, GMS, and AFB stains. Therefore, knowledge of these staining properties and the distinguishing characteristics of PAMRAGs and AMGs enables recognition of this important diagnostic pitfall.

Abbreviations: AMG, actinomycotic granule; IUD, intrauterine device; PAMRAG, pseudoactinomycotic radiate granule; PID, pelvic inflammatory disease; TEM, transmission electron microscopy

Keywords: pseudoactinomycotic granule; actinomyces; intrauterine device; pelvic inflammatory disease; diagnostic errors

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