Periapical actinomycosis: a clinicopathologic study.
OBJECTIVE
We sought to evaluate the incidence and clinical outcome of an accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination.


METHODS
The study included all periapical biopsy specimens submitted for histologic examination between 1997 and 2000. Sections of paraffin-embedded tissues, 5 microm, were cut and stained by using hematoxylin and eosin, periodic acid-Schiff, and the Gram stain. The presence of typical branching colonies of filamentous bacteria staining positive for periodic acid-Schiff and Gram stain was indicative of Actinomyces.


RESULTS
Typical actinomycotic colonies were identified in 17 of 963 (1.8%) periapical biopsy specimens. The mean patient age was 42, and males were predominant (65%). The maxilla was the most frequently involved site (65%), with equal distribution in the anterior and posterior areas. Radiographically, most cases presented as well-demarcated radiolucent lesions. Malignancy was suspected in 3 cases. Of the periapical lesions, 15 were epithelialized, and in 4 cases, a true epithelial-lined lumen was found, which was diagnosed as a radicular cyst. A residual cyst was diagnosed in 1 case, and in 1 case, an epithelial lining was not identified. Treatment included surgical curettage and a short course of antibiotic therapy. Healing was uneventful in all cases.


CONCLUSIONS
Periapical actinomycosis is not common. Its outcome is favorable after surgical curettage supplemented by short-term antibiotic treatment. The relationship of periapical actinomycosis with the more serious cervicofacial actinomycosis should be evaluated.
Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. hirshmdpost.tau.ac.il
Abraham
A
Hirshberg
Igor
I
Tsesis
Zvi
Z
Metzger
Ilana
I
Kaplan
D000190:Actinomyces / Q000254:growth & development / Q000302:isolation & purification; D000196:Actinomycosis / Q000175:diagnosis* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D015169:Colony Count, Microbial; D004396:Coloring Agents; D003475:Curettage; D005260:Female; D006801:Humans; D008297:Male; D008439:Maxillary Diseases / Q000382:microbiology; D008875:Middle Aged; D010483:Periapical Diseases / Q000382:microbiology* / Q000628:therapy; D011842:Radicular Cyst / Q000382:microbiology; D012737:Sex Factors; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D004396:Coloring Agents