IMPRINT CYTOLOGY IN FROZEN SECTION: A DIAGNOSTIC CLUE IN PELVIC ACTINOMYCOSIS MASQUERADING AS BILATERAL OVARIAN MALIGNANCY – A CASE REPORT

Abstract

Pelvic actinomycosis is a chronic invasive inflammatory condition of the female genital tract caused by anaerobic filamentous bacteria, producing suppurative granulomatous inflammation leading to abscess formation, tissue plane invasion, and extensive fibrosis. Pelvic actinomycosis involving the adnexa can closely resemble ovarian malignancy, both on clinical and radiological evaluation. We report a case of a 37-year-old multiparous woman with a history of intrauterine contraceptive device (IUCD) use who presented with abdominal pain and bilateral adnexal masses. Further radiological imaging revealed bilateral complex adnexal mass lesions with obliteration of fat planes with the uterus and focal infiltration into the upper rectum, raising strong suspicion for ovarian neoplasm. Given the marked intraoperative concern for malignancy, frozen section with imprint cytology was performed, which revealed dense inflammatory infiltrate with multinucleated giant cells, suspicious of an infective etiology. Routine histopathological examination demonstrated actinomycotic colonies surrounded by marked xanthogranulomatous inflammation involving bilateral adnexa and omentum. Special stains, including Gram's stain, periodic acid–Schiff, and Gomori methenamine silver, highlighted filamentous organisms, confirming the diagnosis. This case highlights the valuable role of imprint cytology during frozen section in differentiating infective pathology from malignancy.