Figure 5 - uploaded by Ahmed Hassan Fahal
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A. MRI showing a mass occupying the left perineal fat tissue and mildly extending to the right side and gluteal region.
Source publication
A 57 year-old male, from central Sudan, presented to the Mycetoma Research Centre (MRC), Khartoum, Sudan, with a slowly progressive right inguino-scrotal swelling of 35 years duration. He also reported local scrotal pain and itching. The swelling was first noted in 1982 as a small painless mass in the lower inner quadrant of the right gluteal regio...
Context in source publication
Context 1
... were no palpable inguinal lymph nodes and no superficial dilated veins. MRI showed a mass occupying the left perineal fat tissue and mildly extending to the right side and also involving the left side of the scrotum, and the gluteal region ( Figure 5A & 5B). Grains PCR examination revealed Madurella mycetomatis. ...
Citations
... Eventually the disease develops and spreads locally through the fascial planes of the skin to deep structures. 5, 6 In very rare instances the disease has been reported to spread through lymphatic vessels to the regional 35 lymph nodes 6,7 ; additionally, haematogenous metastasis has been reported. Constitutional symptoms are very rare in mycetoma patients but can be seen in those with prolonged durations of disease with secondary bacterial infection and sepsis. ...
... Infrequently it spreads through the lymphatic system to induce a 270 regional mycetoma satellite and, rarely, via the bloodstream to affect other remote organs. [6][7][8] Lymphatic spread is more frequently seen among actinomycetoma patients than in eumycetoma patients, but the explanation is unclear. 6 However, the fact that actinomycetoma is more aggressive and inflammatory and 275 lacks a fibrous capsule around the lesion may contribute to the more frequent lymphatic spread. ...
Mycetoma is a chronic subcutaneous granulomatous disease of the soft tissue and extremities. Herein we report four cases of mycetoma caused by different agents, two caused by Madurella mycetomatis, with Actinomadura madurae and Streptomyces somaliensis affecting the others. These lesions originated at different sites but eventually spread to the inguinal region. The exact mechanism for such spread is still unknown and the clinical presentation of our case series was distinctive and required intensive follow-up for appropriate management.
... Eventually the disease develops and spreads locally through the fascial planes of the skin to deep structures. 5, 6 In very rare instances the disease has been reported to spread through lymphatic vessels to the regional 35 lymph nodes 6,7 ; additionally, haematogenous metastasis has been reported. Constitutional symptoms are very rare in mycetoma patients but can be seen in those with prolonged durations of disease with secondary bacterial infection and sepsis. ...
... Infrequently it spreads through the lymphatic system to induce a 270 regional mycetoma satellite and, rarely, via the bloodstream to affect other remote organs. [6][7][8] Lymphatic spread is more frequently seen among actinomycetoma patients than in eumycetoma patients, but the explanation is unclear. 6 However, the fact that actinomycetoma is more aggressive and inflammatory and 275 lacks a fibrous capsule around the lesion may contribute to the more frequent lymphatic spread. ...
The immune responses in actinomycetoma lesions caused by Streptomyces somaliensis in Sudan were characterized by immunohistochemistry during 1997-1998. In sections stained with haematoxylin and eosin, the inflammatory reaction around the grain was of 2 types. In type I there were 3 zones: a neutrophil zone immediately around the grain, an intermediate zone containing mainly macrophages, and a peripheral zone consisting of lymphocytes and plasma cells. Zone 1 stained positively for CD15 (neutrophils), zone 2 for CD68 (macrophages) and CD3 (T lymphocytes), and zone 3 for CD20 (B lymphocytes). In the type II reaction, there was no neutrophil zone, the grains being surrounded only by macrophages and giant cells. This was confirmed by immunohistochemistry, which demonstrated the presence of CD3 positive cells. Immunoglobulins G and M and complement were demonstrated on the surface of the grain and on filaments inside the grain. Neutrophils and macrophages were recruited into the lesion by complement and were involved in the fragmentation of the grain. The cytokine profile in the lesion and regional lymph nodes was of a dominant Th2 pattern (interleukins-10 and 4).
