Primary gastric actinomycosis: report of a case diagnosed in a gastroscopic biopsy

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• 作者：Khaleel Al-Obaidy (1)
  Fatimah Alruwaii (1)
  Areej Al Nemer (1)
  Raed Alsulaiman (2)
  Zainab Alruwaii (3)
  Mohamed A Shawarby (1)
  
  1. Pathology Department ; College of Medicine ; University of Dammam ; P.O. Box 1982 ; Dammam ; 31441 ; Saudi Arabia
  2. Department of Internal Medicine ; College of Medicine ; University of Dammam ; P.O. Box 1982 ; Dammam ; 31441 ; Saudi Arabia
  3. King Fahd Hospital of the University ; University of Dammam ; P.O. Box 2208 ; Al-Khobar ; 31952 ; Saudi Arabia
  
• 关键词：Actinomycosis ; Gastric ; Grocott鈥檚 ; Gram ; PAS
• 刊名：BMC Clinical Pathology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 全文大小：3,729 KB
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• 刊物主题：Pathology; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1472-6890

文摘

Background Primary gastric actinomycosis is extremely rare, the appendix and ileocecal region being the most commonly involved sites in abdominopelvic actinomycosis. Herein, we report a case of primary gastric actinomycosis. The diagnosis was made on microscopic evaluation of gastroscopic biopsy specimens. To the best of our knowledge, this is the third case to be reported in the literature, in which the diagnosis was made in a gastroscopic biopsy rather than a resection specimen. Case presentation An 87-year-old Saudi male on medication for cardiomyopathy, premature ventricular contractions, renal impairment, hypertension, and dyslipidemia, presented to the emergency department with acute diffuse abdominal pain, abdominal distension, constipation and vomiting for two days, with no history of fever, abdominal surgery or trauma. The patient was admitted to the hospital with an impression of gastric outlet obstruction. Based on radiologic and gastroscopic findings, a non-infectious etiology was suspected, possibly adenocarcinoma or lymphoma. Gastroscopic biopsies showed an actively inflamed, focally ulcerated atrophic fundic mucosa along with fragments of a fibrinopurulent exudate containing brownish, iron negative pigment and abundant filamentous bacteria, morphologically consistent with Actinomyces. Conclusion Althuogh extremely rare, primary gastric actinomycosis should be considered in the differential diagnosis of radiologic and gastroscopic diffuse gastric wall thickening and submucosal tumor-like or infiltrative lesions, particularly in patients with history of abdominal surgery or trauma, or those receiving extensive medication. A high level of suspicion is required by the pathologist to achieve diagnosis in gastroscopic biopsies. Subtle changes such as the presence of a pigmented inflammatory exudate should alert the pathologist to perform appropriate special stains to reveal the causative organism.