|LETTER TO THE EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 82
Why is it a diagnostic dilemma to diagnose female genital tuberculosis: A pathologist's viewpoint
Department of Pathology, Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India
|Date of Web Publication||16-Nov-2016|
Department of Pathology, Rural Institute of Medical Science and Research, Saifai, Etawah, Uttar Pradesh
|How to cite this article:|
Dayal S. Why is it a diagnostic dilemma to diagnose female genital tuberculosis: A pathologist's viewpoint. Saudi J Med Med Sci 2017;5:82
|How to cite this URL:|
Dayal S. Why is it a diagnostic dilemma to diagnose female genital tuberculosis: A pathologist's viewpoint. Saudi J Med Med Sci [serial online] 2017 [cited 2017 Sep 21];5:82. Available from: http://www.sjmms.net/text.asp?2017/5/1/82/194252
The diagnosis of genital tuberculosis is based on clinical symptoms, hematology, imaging, histopathology of the genital tract material and serology., The diagnostic dilemma arises because of the varied clinical presentations, diverse imaging results, bacterial and serological findings in addition to the histopathological characteristics.
| Fallopian Tube|| |
Fallopian tube tuberculosis may present as tuberculous endosalpingitis, tuberculous exosalpingitis and interstitial tubercular salpingitis. Tuberculosis is characterized by the presence of giant cells, caseous necrosis. However, giant cells can also appear as a reaction to previous surgery due to cat gut sutures, sarcoidosis, fungal infection, syphilis and Crohn's disease. The endosalpinx tubal mucosa may show hyperplastic or adenomatous pattern resembling adenocarcinoma.
| Endometrium Tuberculosis|| |
The granuloma of tuberculosis may occasionally perforate into gland lumina causing an acute inflammatory reaction and give the appearance of a micro abscess. Endometrial glands adjacent to the granuloma may not reveal a secreatory response or may become compressed resulting in pseudoacanthomatous appearance.
| Ovary|| |
Tubercular encysted cyst may appear as an ovarian cyst. Pelvic tuberculosis can also stimulate ovarian carcinoma.
| Cervix|| |
The cervix may show frank papillary or ulcerative lesions which may stimulate carcinoma cervix on gross examination. In cervix caseating non-tubercular, granuloma caused by lymphogranuloma venereum or sarcoidosis may be encountered in the cervix. Cervix granuloma may occasionally develop after a biopsy or surgery as a reaction to local tissue necrosis.
| Vulva and Vagina|| |
Lesions on the vulva and in the vagina may be hypertrophic lesions which resemble malignant lesions. Giant cells of the foreign body type are encountered frequently in vulvar tissue in which a previous biopsy has been performed. The giant cells associated with non-caseating granuloma often result from embedded sutures, occasionally seen in biopsied areas and should not be confused with tuberculosis.
However, a detailed clinical history, examination and combination of hematology, Roentgenographic examination, ultrasonography, laproscopy, histopathology and culture are important factors in ruling out out female genital tract tubercular pathology.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Padubidri VG, Daftary SN. Tuberculosis of the genital tract. In: Howkin's & Bourne Shaw's Textbook of Gynaecology. 12th
ed. New Delhi: Churchill living stone; 1990. p. 229-238.
Gatongi DK, Gitau G, Kay V, Ngwenya S Lafong C, Hasan A. Female genital tract tuberculosis. Obstet Gynaecol 2005;7:75-9.
Thakkar NA, Varma TR. Genital tuberculosis. In: Sengupta BS, Chattopadhyay SK, Varma TR, editors. Gynaecology for post graduates and Practitioners. 2nd
ed. New Delhi India: Elsevier, 2007. p. 431-442.
Czernobilsky B. Endometritis and infertility. Fertil Steril. 1978; 30:119.
Richens J. Genital manifestations of tropical disease. Sex Transm Infect 2004; 80:12-17.
Evans C S, Gold man R L, Klein HZ. Necrobiotic granulomas of the uterine cervix. A probable post operative reaction. Am J Surg Pathol. 1984; 8: 841-844.
Wilkinson E, Lin Xie D. Benign disease of the vulva. In: Mark E Sherman, Michael T, Mazur, Kurman Robert J, editors. Blaustein 's pathology of the female genital tract. 5th
ed. New Delhi, Elsevier, 2004: 432.