Pelvic Tuberculosis

Pelvic Tuberculosis

• Tuberculosis of the genital tract – chronic salphingitis, chronic endometritis– frequent cause of chronic PID and infertility (Asia,

Middle East, Latin America)– occur in post menopausal women 10% of the time

Pelvic Tuberculosis

• caused by by either Mycobacterium tuberculosis or M. Bovis

• LUNGS – primary site of infection→ spread hematogenously → oviduct

- Oviduct – primary and predominant site of pelvic tuberculosis

Pelvic Tuberculosis

• predominant presentation – infertility and abnormal uterine bleeding – mild to moderate chronic abdominal and pelvic

pain occur in 35% of women• pelvic examination are normal in approximately 50% of

cases

Pelvic Tuberculosis

• Diagnosis – endometrial biopsy– findings: Giant cells, granulomas, caseous necrosis

• “tobacco pouch” appearance

Source: Comprehensive Gynecology by Katz

Pelvic Tuberculosis• Pelvic TB – common in 20-40 years of age• Common symptoms:– pelvic pain, menstrual irregularity and infertility

• Ulcerative or exophytic representing primary malignancy

• Source: CERVICAL TUBERCULOSIS: AN IMPORTANT DIFFERENTIAL DIAGNOSIS OF CANCER CERVIX Case Report Ind. J Tub., 2003, 50, by Anil P. Sakhare1, Arun R. Mahale2 and Lata T. Dumne3

Pelvic Tuberculosis

• Pelvic tuberculosis (PT) infection is usually caused by reactivation of organisms from systemic distribution of Mycobacterium tuberculosis during primary infection.

• Direct transmission between sexual partners has been documented although very rare.

• typically presents with pelvic pain, infertility, poor general health or menstrual disturbances

• less common presentations included an adnexal mass, ascites or both

• CA 125 - tumor-associated antigen, is a nonspecific marker of ovarian; elevated in a variety of conditions:

• Infections• Tuberculosis• endometriosis • Meigs syndrome,• Menstruation• ovarian hyperstimulation• non-gynaecologic conditions like active hepatitis, acute pancreatitis,

pericarditis, pneumonia

• diagnosis of PT is confirmed by histological examination of frozen or paraffin-embedded sections, positive acid fast stain and positive culture of endometrial biopsy tissue*epitheloid cell granuloma with or without

Langerhans giant cell• Hysteroscopy• Laparoscopy• Abdominal Paracentesis – using the PCR

Source:Pelvic Tuberculosis: The Great Simulator of Gynaecologic

Malignancies

Carla Pina*, Marcília Teixeira*, Diana Cruz†, Eduardo Ferreira‡, Mari Mesquita†, Ana Torgal*

*Departamento de Ginecologia, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel; †Departamento de Medicina Interna, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel; ‡Laboratório de Anatomia Patológica Dr. Eduardo Ferreira, Porto

Pelvic Tuberculosis

• Genitourinary Tuberculosis accounts for about 15% of all extra pulmonary TB.– Hematogenous spread → primary infection