Cancer-like presentation of female genital tuberculosis

Tuberculosis of the female reproductive tract affects usually reproductive age group and is a common cause of infertility with tubal pathology. Diagnosis of the female genital tract tuberculosis is challenging and, very often missed due to the unusual presentations and lack of specific diagnostic tests. This may occasionally lead to unnecessary surgical procedures. We present two case reports of female genital tuberculosis (FGTB) who presented to us with symptoms mimicking malignancy diagnosed TB only on histopalthology.

Hypertrophic tuberculosis of vulva--a rare presentation of tuberculosis

The authors report a rare case of hypertrophic vulval tuberculosis of primary origin in a 26-year-old female patient. The diagnosis was mainly based on histopathological examination. Good outcome was obtained with antitubercular chemotherapy supplemented with surgical reduction for aesthetic concern.

Pelvic tuberculosis continues to be a disease of dilemma--case series

Tuberculosis (TB) has become a global epidemic again with emergence of HIV/AIDS and multi-drug resistant strains of TB. Female genital tuberculosis (GT) is typically a disease of young women and its occurrence in post menopausal women is rare. Amongst the genital disorders, GT is the most baffling especially because of its various presentations. So GT is notorious for evading diagnosis. A series of cases of females GT between the age 25 yrs to 40 yrs is being reported with women having spectrum of clinical features, creating diagnostic dilemma and so final diagnosis by histopathology after laparotomy. So a high degree of suspicion aided by intensive investigations may be required for the diagnosis of GT. Medical therapy is the main treatment, however some do need surgery. Research needs to be continued for early establishment of timely diagnosis of GT and modalities of effective therapies.

[TUBERCULOUS SALPINGITIS IN THE STAGE OF CALCIFICATION TO CASEOUS NECROSIS IN TEENAGE GIRL]

The authors observed a case of pinched, calcified, caseously degenerated right uterine appendages in girls aged 14 and 11 years. The disease showed mild symptoms and it was occasionally detected by intravenous urography. Both patients underwent surgery--elimination of tuberculous salpingitis with calcified caseous necrosis. No treatment in the former case and specific treatment in the latter led to two different outcomes: late recurrence and recovery. Pinched, calcified, caseously degenerated uterine appendages are a rare pathology in children in particular. Ovarian dermoid cysts and calcified lymph nodes are differentially diagnosed. Diagnosis and treatment require surgical intervention (laparotomy, laparoscopy), sanitization of an infection focus, chemotherapy.

[Unilateral salpingian and ovarian TB, a rare form of extrapulmonary TB]

TB salpingitis and ovarian TB is a rare association of extrapulmonary tuberculosis, especially when the lesions are not associated with lung involvement. The correct therapy leads to the sterilization of the tuberculosis foci, although the risk of scars and adhesions is high, causing local functional disorders.

Management of bilateral fallopian tube carcinoma coexistent with tuberculous salpingitis

Primary carcinoma of the fallopian tube is a rare gynecologic malignancy. Chronic tubal inflammation is associated with primary carcinoma of the fallopian tube. There are only a few reports on primary carcinoma of the fallopian tube coexisting with tuberculous salpingitis. We are reporting a patient with both the primary carcinoma of the fallopian tube and tuberculous salpingitis, which were detected in bilateral fallopian tubes. The histologic type was serous adenocarcinoma. The patient was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and bilateral pelvic lymphadenectomy followed by chemotherapy consisting of paclitaxel and cisplatin. She has been alive without evidence of disease for 18 months.

[A case of advanced genital tuberculosis--differential diagnostics and surgical aspects]

The authors report a case of advanced genital tuberculosis. The diagnostic difficulties and treatment are discussed.

Genital and peritoneal tuberculosis: potential role of laparoscopy in diagnosis and management

Genital and peritoneal tuberculosis are rare in developed countries and can mimic ovarian cancer. We report two different cases that came to our attention, both in a month. The first patient was referred to us for an asymptomatic pelvic mass. The second patient came to us because of weight loss, abdominal swelling, and ascites. Unfortunately, the imaging findings were misleading, and the laboratory analyses were not helpful. Only the laparoscopic approach was useful for final diagnosis. We conclude that the symptoms of abdominal tuberculosis vary greatly, and laparoscopy can be essential for its diagnosis and management.

[Genital tuberculosis and surgical treatment of it]

The paper presents the specific features of diagnosis and clinical course of genital tuberculosis under the present conditions. It shows it expedient to make a differential diagnosis of genital tuberculosis in 2 steps: 1) the use of the routine examination and 2) the study of specific antituberculous immunity. Genital tuberculosis risk groups to be obligatorily examined at a specialized tuberculosis control facility are identified. The specific features of the clinical course of genital tuberculosis, such as aptness to exudative processes, a combination with extragenital tuberculosis and hormonally depended gynecological diseases are noted. Indications for and efficiency of endosurgical interventions in genital tuberculosis are shown.

[Features of surgery on female genital tuberculosis]

The paper gives the outcomes of treatment in 4983 patients treated at the Gynecology Clinic of the Saint Petersburg Research Institute of Phthisiopulmonology in 1977 to 1999. Surgical interventions different in their scope were made in 949 (19%) females. Analyzing 526 females of them indicated that organ-saving operations were performed in most cases (80.2%). Indications for surgery and the time of preoperative etiotropic therapy were defined. Emphasis is laid on that the introduction of laparoscopy into practical phthiosiologic gynecology will solve many problems associated not only with a surgical appliance, but also with the diagnosis of genital tuberculosis.

[Ovarian tuberculosis]

Although the tuberculosis rate in Germany and in the Western industrialized nations is stable, it is still one of the most significant infectious diseases worldwide. Immigrants and asylum seekers make up a large proportion of new cases, and with 15%, the occurrence of multidrug-resistant tuberculosis patients from the former Soviet Union is above average. This study, describing a patient with ovarian tuberculosis, undertakes a classification of risk groups as well as presents the potential differential diagnosis and its limitations.

Genital tuberculosis in a menopausal woman. A case report

We have analysed the role played by genital tuberculosis (TBC) in Italy today, and in particular in L'Aquila, in the light of a worrying recrudescence. We report the case of a 64-year-old patient, in menopause for the past 11 years or so, referred to the Gynecology and Obstetrics Clinic of the University of L'Aquila, with an anamnesis of menometrorrhagia since the age of 55. The patient was studied from a gynecological and internist profile including the following procedures: gynecological examination and pap-test, colposcopy, transvaginal scan, chest X-ray, abdominal and pelvic CAT, laboratory tests and Mantoux reaction. The uterus was found to be fibromatous during the gynecological examination and scan, whereas colposcopy revealed a small ectropion and the presence of very adherent yellowish mucus. The Mantoux test was positive. CAT showed cicatricial sequelae in the pulmonary parenchyma. It was decided to perform curettage, but this was prevented by the presence of pyometra. The patient was treated with specific chemotherapy and then underwent total laparohysterectomy with bilateral adnexectomy. The histological findings confirmed genital TBC. Genital TBC is now undergoing a worrying recrudescence. We need to have a full knowledge of the pathology, the diagnostic means with which to discover it and the correct therapeutic instruments to overcome it.

Female genital tuberculosis: clinical features and trend

A retrospective study of genital tuberculosis in women attending the Department of Obstetrics and Gynecology between January 1986 and December 1997 revealed 11 patients with a mean age of 38 years (range 23-77). Two patients had genital tuberculosis and tuberculous peritonitis. The incidence was 0.01 per cent of outpatients and 0.05 per cent of inpatients. Eight cases occurred during the last six years. Although the incidence was quite low, a rising trend was observed. Of the clinical features, infertility was the commonest initial symptom (3 cases). The most common site of infection was the endometrium (5 cases) followed by fallopian tube and ovary (3 cases). Chest X-ray of all patients showed no lung infiltration while AFB staining and PCR for tuberculosis were positive in two out of five and one out of two respectively. Six patients received medical treatment only, and three were treated with antituberculous drugs after surgery; all with good results. Tubal reconstructive surgery was performed in two patients without medical treatment. Gynecologists should be aware of this disease to facilitate early diagnosis and treatment.

[Tuberculous tubo-ovarian abscess as a distant complication of Caesarean section]

A 37-year-old patient, two mounts after the third caesarean sections, was rehospitalised due to severe lower abdomen pains and fever. She had been treated with antibiotics several times with no apparent result. Laparotomy was performed and the tubo-ovarian abscess was resected. The histological diagnosis was--adnexal tuberculosis. The postoperative period was febrile with prolonged inguinal lymphatic nodes reaction. She was constantly treated with broad-spectrum antibiotics and left hospital after 30 postoperative days. The disease was probably the result of symptomless lung tuberculosis, she had suffered from in the past.

Genital tuberculosis in a HIV infected woman: a case report

The incidence of HIV-associated tuberculosis is increasing worldwide, especially in developing countries. HIV infected patients rapidly develop clinically significant disease, respond poorly to complete treatment and present with extrapulmonary tuberculosis. Although a relative increase of genital tuberculosis would be expected, this has not been reported. Probably, tuberculous systemic disease is diagnosed earlier, before genital tuberculosis occur. The present study is a report of case of a young African female patient, who was admitted with symptoms of acute pelvic inflammatory disease due to genital tuberculosis and proved to be HIV infected. The patient was managed by intravenous antibiotic administration, but since no clinical or laboratory improvement was achieved, a laparotomy and salpingooophorectomy was performed. Histopathology revealed tuberculosis and after that the patient proved to be HIV infected. Further investigation did not reveal pulmonary or other extragenital manifestation of tuberculosis. The only manifestation of HIV infection and genital tuberculosis was the symptoms of an acute pelvic inflammatory disease, which is extremely rare.

[Clinico-morphological manifestations of genital tuberculosis in women]

Surgical material from 35 female patients with genital tuberculosis is analyzed. 57.1% of patients with clear-cut clinical symptoms showed tubercles and caseous foci. In other patients no specific pathology was found histologically. This condition can be called as a non-active tuberculosis if clinicoepidemyologic data and laboratory studies support diagnosis of tuberculosis. Natural evolution of the specific inflammation and its trend to fibrosis facilitate the development of secondary infection. In this respect tuberculosis of female genitalia resembles pulmonary tuberculosis.

[Genital tuberculosis--increased incidence or coincidence]

Genital tuberculosis is a rare disease in industrialized countries. Symptoms like bleeding disorders, sterility and lower abdominal pain lead to endoscopic examination. Laparoscopic findings are often misinterpreted, so that histology clears the diagnosis. Three cases are reported.

Cytodiagnosis for pelvic tuberculosis

A 25 yr old married woman with complaints of lower abdominal pain for 2 months, was found to have a irregular nontender mass in pelvis, adherent to uterus. Her Papanicolaou smear was inflammatory. To confirm the diagnosis of either ovarian malignancy or pelvic tuberculosis made on the basis of observations during exploratory laparotomy, ovarian biopsy was taken. The imprint cytodiagnosis was tuberculosis. The patient was then managed surgically and the previous diagnosis was reconfirmed by histopathology. Imprint cytodiagnosis appears to be a valuable technique whenever facilities for frozen section are not available.

Tuberculous endometritis presenting as postmenopausal bleeding. A case report

Genital tuberculosis presented as postmenopausal bleeding in a woman with third-degree procidentia. After two months of combination antimycobacterial treatment, she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by nine months of postoperative drug therapy.

[Sarcoid reaction to a foreign body located in the uterus and the liver]

A case is reported of a sarcoidosis reaction within the uterine wall which developed following the vaginal injection of an unknown substance for contraceptive purposes. The reaction spread through the body to affect the lymphnodes and liver. Can this serve as an experimental model for the various forms of sarcoidosis observed clinically, notably genital sarcoidosis?

[Surgical treatment of tuberculosis of non-pulmonary localization]

Experiments in 86 rabbits and observation of 360 patients have shown the antibacterial therapy to be of limited use for the treatment of non-pulmonary tuberculosis. It was found that the antibacterial therapy failed to result in healing the caseous-destructive foci and to cure turebculosis of kidneys, bones, joints, female genitals and lymph nodes. It is considered to be a reason for surgical procedures according to principles of the focal surgery on non-pulmonary tuberculosis elaborated by P. G. Kornev and his school.

Female genital tuberculosis and consequent infertility

During the years 1971-1980, genital tuberculosis was found in seven patients examined for infertility at the Department of Obstetrics and Gynaecology, Turku University Central Hospital. None of these patients had a previous history of tuberculosis manifestations. Chest X-ray examinations were normal for all patients. Six of the patients had tuberculous endometritis. Infertility was the only one had tuberculous endometritis. Infertility was the only symptom for these patients. The findings for the hysterosalpingogram were varied and generally not typical of genital tuberculosis described in the literature. All diagnoses were confirmed histologically. Two cases of full-term pregnancy after treatment of genital tuberculosis are described. In one case there was a purulent tuberculous salpingo-oophoritis and in the other case there were tuberculous implants at the surfaces of the uterus and ligamentum latum. In addition two cases of extrauterine pregnancy are described.

Surgical treatment of tuberculosis of the female genital tract

A study has been made of 91 women with proved tuberculosis of the genital tract treated by surgery between 1st January, 1951 and 15th October, 1979. In 77 the operation was performed during anti-tuberculosis drug therapy. In the remainder the diagnosis was made after operation and drug therapy was started as soon as possible thereafter. The indications for operation were paid (40 patients), pelvic masses (36 patients), recurrence of endometrial tuberculosis (10 patients), uterine bleeding (3 patients) and suspicion of endometrial neoplasia (2 patients). Total hysterectomy with removal of both tubes and ovaries was done in all patients except two, in whom pelvic clearance was not technically feasible. No patient developed a fistula and there were no deaths. All patients were well at follow-up.

Hypertrophic tuberculosis of the vulva

Hypertrophic tuberculosis vulvae is a rare genital infection. Treatment is essentially with antitubercular drugs. However, when the hypertrophy is so excessive that it interferes with normal life, surgical treatment is necessary. A case is presented in which combined treatment by surgery and antitubercular drugs restored the patient's health.

Twenty-five years experience of the drug treatment of tuberculosis of the female genital tract

A study has been made of women with proved, tuberculosis of the genital tract who were treated with drugs between 1st January, 1951, and 1st July, 1976. Seven different drug programmes were employed and 566 women were treated. Apart from the last two schedules employing the newer antituberculosis drugs, which were too recent for a follow-up to be available, the best results were obtained with a combination of streptomycin, PAS and isoniazid for 18 months or two years. In this group, 87.7 per cent were regarded as cured after an average follow-up of six years and six months. Drug cover was employed in 79 patients in whom surgery was found to be necessary and the results were uniformly satisfactory. Toxic drug reactions occurred in 18.2 per cent of the patients treated.

[Isolated tortion of the fallopian tube. Report on a recurrent tortion of a hematosalpinx due to genital tuberculosis (author's transl)]

A case of recurrent contralateral isolated tortion of tubercle hematosalpinx four years after the first event is reported. The clinical picture and the pathogenesis of the isolated tortion of the fallopian tube is discussed. This disease is considered to be rare and the etiology of isolated tortion of the tube is largely unknown. As shown in this case, tortion of the tube can occur in cases of genital tuberculosis. Since acute bleeding into the fallopian tube may be pathognomonic for tortion this factor should be considered when the findings at laparotomy are interpreted. Tortion of a hematosalpinx requires additional diagnostic measures to detect the underlying disease.

Gynaecological tuberculosis, past, present and future

Until the introduction of the anti-tuberculosis drugs about 25 years ago, the treatment of tuberculosis of the female genital tract was generally unsatisfactory although many different forms of therapy were employed. Surgery was associated with a high incidence of post-operative complications, particularly of fistula, and an appreciable mortality rate. The position improved greatly after the introduction of the anti-tuberculosis drugs. Several drug programmes were employed by the writer, the best results being obtained with a combination of streptomycin, PAS and isoniazid for at least 18 months. Where drug treatment had failed, or where pelvic masses developed, surgery under drug cover was employed. No serious complications and no fatalities occurred in these patients. The question of possible transmission through sexual intercourse of male genitourinary tuberculosis is being investigated. A new drug programme is now being employed, the drugs used being streptomycin, ethambutol and isoniazid.