Nested polymerase chain reaction on vaginal smears of tuberculous cervicitis. A case report

Vaginal sarcoidosis without other organ involvement in a patient with a history of endometrial cancer: A case report

•Patient with history of endometrial cancer presented with vaginal discharge.•Biopsy showed non-necrotizing granulomas, potentially sarcoidosis.•She responded to steroids with symptom resolution.

Sarcoidosis of the vagina treated with methotrexate

We describe the first case of mediolateral episiotomic sarcoidosis of the deep vaginal tissue, without involvement of the pulmonary parenchyma or pulmonary symptoms. A 68-year-old female was admitted with a vaginal mass that had developed about 1 month prior. On bimanual examination, we found a painful solid mass approximately 4 cm in diameter on the episiotomy line of the deep vaginal tissue. The patient underwent pelvic magnetic resonance imaging on suspicion of a malignancy, and a vaginal true-cut biopsy was performed. The biopsy specimen exhibited non-caseating, granulomatous inflammation and many multinucleated giant cells, strongly suggesting sarcoidosis. We had excluded other granulomatous diseases; a final diagnosis was made of stage-1 sarcoidosis in the deep vaginal mass. A 3-month course of methotrexate (2.5 mg/week) was commenced to treat a flare-up of rheumatoid arthritis. The vaginal mass resolved. To the best of our knowledge, this is the first case of sarcoidosis in a deep vaginal mass without pulmonary parenchymal or other solid-organ involvement.

Post-menopausal endometrial tuberculosis mimicking carcinoma: An important differential diagnosis to consider

We report the case of a menopausal 74-year-old patient who presents pyorrhoea for 6months. We suspect initially a carcinoma process, but the anatomopathological examination takings obtained by biopsy curettage of the endometrial under hysteroscopy is in favor of an inflammatory infiltrate with epithelioid and giant cells of type Langhans and type Muller without caseous necrosis. The bacteriological direct examination after coloring of Gram, Ziehl-Neelsen and Sabouraud was negative. The bacteriological culture in the Löewenstein and Coletsos environment identified Mycobacterium tuberculosis. The searches for another source of the infection was negative both at the pulmonary and urinary levels. An antituberculous quadritherapy allows the fast clinical improvement. The tuberculosis remains frequent but rarely genital. It is especially the case of young women, from non industrialized countries, consulting for infertility. It is necessary to know how to evoke it front in pelvic symptoms, whatever the age is and to realize easily mycobacteriological examinations.

Diagnosis of tuberculous cervicitis by Papanicolaou-stained smear

Tuberculosis (TB) is a common infection in the developing countries. It can involve most organs. Genital TB is usually secondary to pulmonary or extragenital TB. Tuberculosis most commonly involves the upper genital tract. Involvement of the cervix is rare. In countries like India, where carcinoma of cervix is very common, cervical TB may easily be mistaken clinically for malignancy. We report a case of tuberculosis cervicits (secondary to pulmonary tuberculosis) in a 54-year-old postmenauposal woman, who presented with a complaint of discharge per vaginum for a short duration. Per speculum examination showed an ulcerated lesion over anterior lip of cervix, clinically suggestive of malignancy. However, a Papanicolaou-smear showed features suggestive of tuberculosis which was confirmed by biopsy, resulting in early diagnosis and treatment of the patient. Hence, in a patient with a suspicious cervical lesion and a prior history of tuberculosis, a diagnosis of cervical tuberculoiss must be considered.

Vaginal involvement in a patient with sarcoidosis

We report the case of a woman who presented with vaginal symptoms and was proven to have biopsy-confirmed sarcoidosis of the vaginal wall. To our knowledge, this is the first reported case of this entity. An additional unusual finding was that her symptoms of gynecologic sarcoidosis occurred at the time of initial presentation of her pulmonary sarcoidosis.

Cervical tuberculosis detection in Papanicolaou-stained smear: case report with review of literature

Genital tract tuberculosis is usually secondary to an extragenital tubercular focus. Cervical tuberculosis, however, is rare accounting for up to 3% of all genital tract diseases. The diagnosis of tuberculosis is usually established on multiple cervical biopsies followed by bacteriological confirmation. There are only a handful of reports on the diagnosis of tubercular cervicitis in cervical smears. We hereby report a case of cervical tuberculosis which was diagnosed on cervical smear. We also carried out a brief literature review of the cases diagnosed previously on cervical smear.

Facial granulomatous diseases: a study of four cases tested for the presence of Mycobacterium tuberculosis DNA using nested polymerase chain reaction

The histopathologic diagnosis of cutaneous tuberculosis (CTB) is often troublesome, because there are several other entities (tuberculids, demodicidosis, granulomatous rosacea, and acne agminata) that may display granulomatous inflammation with caseation necrosis. The current study describes four cases of granulomatous disease of the face. The final diagnosis (assessed on the basis of the clinical response to therapy) was CTB in three cases and granulomatous rosacea in one case. Histologically, epithelioid granulomas were a constant feature; in one case of CTB, they displayed a palisading (granuloma annulare-like) arrangement. Caseation necrosis was a prominent feature only in the case of granulomatous rosacea. Routinely processed biopsy specimens were evaluated with nested polymerase chain reaction (nPCR) for Mycobacterium tuberculosis (MBT) DNA. The correlation between nPCR results and clinical outcome was less than optimal; in fact, one case showed an excellent clinical response to the antituberculous drug therapy despite the absence of MBT DNA amplification. In granulomatous diseases of the face, the importance of evaluating not only nPCR but the overall clinicopathologic picture so as to avoid diagnostic misinterpretations is emphasized.