PART TWO
Diagnostic Cytology
Fig. 7.28
A c tin o m y c e s .
(A) Vaginopancervical smear (Papanicolaou x LP).
Fig. 7.29 Colonies of
A c tin o m y c e s .
(A) Note the numerous filamentous
(B) LBGS (Papanico|aou x LP).
structures radiating from the center. Vaginopancervical smear (Papanicolaou
x HP). (B) Higher magnification of the colonies of
A c tin o m y c e s
(Papanicolaou x HP).
A number of organisms, including
Candida,
dermatophytes,
and
Nocardia,
along with bacterial aggregates, and foreign
substances such as sulfa drug crystals and contraceptive creams,
may resemble
Actinomyces
organisms.
Hematoidin
crystals
described by Hollander and Gupta6 have a resemblance to sulfur
granules. The differential diagnosis of
Actinomyces
as seen in the
vaginopancervical smear is presented in Table 7.4.
We believe that genital
Actinomyces
is an exogenous infection.
Orogenital contact may be an important mode of acquiring the
genital
Actinomyces
infection. The "tail" of the IUD most likely
acts as a carrier for the ascent of the organisms. The tissue dam-
age produced by the body and edges of the IUD causes a change
in the oxygen reduction potential and alteration in the micro-
bial milieu of the lower genital tract. The changed environment
is conducive to the growth of these organisms.
Actinomyces
has been observed with all types of IUDs, including currently
marketed models. Infection is more common with devices
with polyfilamentous thread and with angular forms.
Key features of genital
Actinomyces
• Always associated with an IUD or a foreign body;
• May cause no symptoms;
• Occur as dark, woolly clumps (Gupta bodies);
• Parallel filaments, branching at acute angle;
• Difficult to culture; and
• May be confirmed by special stains.
Occasionally,
Actinomyces
may occur in association with
"black yeast," a fungus
Aureobasidium pullulans,
commonly found
in areas with poor hygienic conditions. It has large, dark-fruiting
bodies (Fig. 7.31). As reported by de Moraes-Ruehsen and asso-
ciates,
Entamoeba gingivalis,
a protozoan of the oral cavity, may
be found in association with
Actinomyces
in vaginal specimens45
(Fig. 7.32). An orogenital route of this
Actinomyces
infection is
a distinct possibility. These nonpathogenic protozoa should be
distinguished from
Entamoeba histolytica
that occur in the alimen-
tary tract and which may also cause lower genital tract infection.
IUD-Associated Cellular Changes
In addition to the alterations in the microbial environment and
Actinomyces
infection, usage of the IUD is associated with cellular
changes occurring in the various genital tract epithelia, as early
as 10-12 weeks after an IUD insertion. These result from chronic
irritation by the IUD tail and the body affecting the adjacent
tissues within the endocervix and the uterine cavity. It is impor-
tant to recognize these morphologic features as they can mimic
102
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