actinomyces is a gram - positive , nonspore - forming anaerobic or microaerophilic rod - shaped bacteria . fine needle aspiration ( fna ) diagnosis of actinomycosis is rare , although , the infection is well - documented in exfoliative cytology in relation to intrauterine device users . we report here , a case of vulvar actinomycosis masquerading clinically as malignancy and diagnosed by fna cytology . a 60-year - old female presented to the gynecologist , complaining of gradual enlargement of a right - sided tender vulvar mass . the mass was of 15 cm  10 cm size , firm - to - hard , and fixed to the underlying soft tissue . considering the age of the patient , the presence of a hard , fixed mass raised the suspicion of a malignancy . she had an unremarkable gynecologic history , including normal pap smear ; no intrauterine contraceptive device ( iucd ) was used . on local examination , the skin was found to be smooth and showed as though healed and few active discharging sinus with yellowish granules . the slides were stained with hematoxylin and eosin ( h and e ) , papanicolaou stain , may - grnwald - giemsa ( mgg ) stain , and ziehl - neelsen stain was done to rule out tuberculosis . the colonies showed branching , and were surrounded by radiating , hyaline , eosinophilic material representing the splendore - hoeppli phenomenon and exudates of neutrophils [ figure 1 ] . gram staining revealed gram - positive branching filaments . a diagnosis of actinomycosis was made and excisional biopsy was advised . the excisional biopsy also revealed abscesses with actinomycotic colonies surrounded by neutrophils and chronic granulation tissue . the patient responded very well to a course of penicillin , and edema over the right leg markedly reduced in 15 days . actinomycosis is seen as a genital infection in females as well , particularly those with a history of iucd usage . our case illustrates an atypical presentation of actinomyces israelii as a large vulvar mass in a postmenopausal patient mimicking vulvar carcinoma . the lesion appears as single or multiple indurated mass ; these lesions are often mistaken for neoplasms . the disease starts as a suppurative , inflammatory process , and then proceeds on to become a chronic inflammatory lesion . these abscesses discharge multiple pinhead - sized , yellowish sulfur granules that are actually aggregates of microorganism , which is a characteristic feature of this disease . they can be visible macroscopically and/or microscopically . cytologically , h and e stained sections show colonies of filamentous actinomyces bacteria with peripherally situated , radiating , hyaline eosinophilic material representing the splendore - hoeppli phenomenon . there is dense polymorphonuclear infiltration around each colony , surrounded by chronic granulation tissue . other stains that can be used to identify the organisms are gram and silver stains . polymerase chain reaction using the 16 svedberg ( s ) ribosomal rna gene amplification has been developed for the diagnosis of actinomycosis . diagnosis of actinomyces israelii is difficult , as even one dose of antibiotics prior to culture can obscure results . culture requires 5 - 7 days but may take 2 - 4 weeks . because our patient was postmenopausal , with no evidence of iucd , actinomyces israelii was not suspected . treatment classically begins with intravenous ( iv ) penicillin for 2 - 6 weeks , followed by oral therapy with penicillin or amoxicillin for 6 - 12 months . pelvic infections involving actinomyces in association with the use of iucds are well established . in conclusion thus , biopsies and cultures are both mandatory while evaluating vulvar masses suspicious for malignancy . therefore , an early diagnosis by fna cytology is warranted for effective antibiotic therapy and surgical resection .
actinomycosis is a chronic infection caused by actinomyces israelii , usually seen in immunocompromised patients or in the background of tissue injury . 
 vulvar actinomycosis presenting as a fixed swelling in an elderly individual can mimic malignancy and pose a diagnostic dilemma . 
 we report here a case of vulvar actinomycosis diagnosed by fine needle aspiration ( fna ) . a 60-year - old postmenopausal female presented with a gradually increasing 15 cm  10 cm vulvar swelling involving the right mons and right labia majora . 
 the swelling was nodular , fixed , and nonulcerated , with multiple healed and few active discharging sinus tracts draining serosanguineous fluid and yellowish sulfur granules . 
 fna was diagnostic , as it revealed colonies of actinomyces surrounded by polymorphs . 
 histopathology of excised specimen confirmed the cytological findings . 
 fna is an effective tool in the diagnosis of actinomycosis , although , its documentation is rare . 
 difficulties in the management can be avoided by early diagnosis using the fna technique .