Actinomyces on a papanicolaou smear following a radical trachelectomy

Although the long term efficacy of radical trachelectomy has yet to be established, increasing numbers of women with early stage cervical cancer are being treated with this operation. The procedure involves removal of the primary site of disease with wide surgical margins including the parametrial tissue while preserving the uterine corpus. A purse-string suture is inserted around the uterine isthmus using a non-absorbable suture in order to maintain ‘isthmic competence’ and thereby reduce the risk of miscarriage and preterm labour. It is performed together with pelvic lymph node dissection, usually carried out by a laparoscopic technique. Pregnancy rates have been reported as 61% (8/13) following this procedure with a mean follow up period of 23 months (range 1–64). The association of actinomyces-like organisms on a papanicolaou smear with an intrauterine contraceptive device is well established. Intrauterine contraceptive device users with actinomyces-like organisms on a smear are more likely to have clinical and cytological evidence of pelvic inflammation. Actinomyces pelvic infection is rare but the sequelae include abdominal pain, vaginal discharge, bleeding per vaginam, endometritis, endocervicitis salpingitis and tubo-ovarian abscess. These complications could potentially comprise fertility. We report the first case of actinomyces-like organisms on a papanicolaou smear from a woman who had undergone treatment by radical trachelectomy.