Abstract
Background The aim of the present study was to analyze the clinicopathological and the ultrastructural features of periapical actinomycosis (PA) cases. Material and Methods Data from the files of an oral pathology laboratory were retrieved and the findings of histopathological analysis were evaluated. Hematoxylin–eosin (HE), a modified Brown & Brenn, and Grocott stains as well as ultrastructural analysis using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) were utilized. Results Six cases were obtained, 4 females and 2 males, with a mean age of 34 year-old. Two cases were symptomatic, lower teeth and the anterior region were more commonly affected, and all cases were characterized by periapical radiolucencies. All cases presented sulfur granules with a ray-fungus or club-shaped pattern of the Splendore-Hoeppli phenomenon in HE-stained sections, with filamentous gram-positive bacteria aggregates highlighted by the modified Brown & Brenn stain. SEM analysis revealed abundant packed rod-like and filamentous bacteria associated with an extracellular amorphous material. EDX analysis showed predominant picks of calcium and sulfur in actinomycotic colonies. Conclusions Our findings suggest that PA manifests either clinically and radiologically as a non-specific and heterogeneous condition and that the actinomycotic colonies consist in a calcium- and sulfur-rich matrix. Furthermore, the results highlight the importance of submitting periapical specimens after surgical removal to histopathological analysis. Key words:Actinomyces, actinomycosis, periapical diseases.
Highlights
Actinomycosis is a chronic infectious disease caused by obligatory or facultative anaerobic gram-positive bacteria belonging to the genus Actinomyces [1,2]
Six cases of periapical actinomycosis (PA) were enrolled in this study and all six patients with PA underwent surgical curettage/enucleation of the lesions as part of the treatment
scanning electron microscopy (SEM) analysis revealed abundant packed rod-like and filamentous bacteria associated with an extracellular amorphous material and calcification
Summary
Actinomycosis is a chronic infectious disease caused by obligatory or facultative anaerobic gram-positive bacteria belonging to the genus Actinomyces [1,2]. It was firstly described in humans probably in 1878 by Israel and Wolfe, who isolated these organisms in culture [3,4]. We characterized the clinicopathological and ultrastructural features of six PA cases, emphasizing the importance of submitting periapical specimens after surgical removal to histopathological analysis. All cases presented sulfur granules with a ray-fungus or club-shaped pattern of the Splendore-Hoeppli phenomenon in HE-stained sections, with filamentous gram-positive bacteria aggregates highlighted by the modified Brown & Brenn stain. The results highlight the importance of submitting periapical specimens after surgical removal to histopathological analysis
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