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*, Marclia Teixeira*, Diana Cruz, Eduardo Ferreira, Mari Mesquita, Ana Torgal* *Departamento de Ginecologia, Centro Hospitalar Tmega e Sousa, EPE, Penafiel; Departamento de Medicina Interna, Centro Hospitalar Tmega e Sousa, EPE, Penafiel; Laboratrio de Anatomia Patolgica Dr. Eduardo Ferreira, Porto

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