Female genital tuberculosis: a global review

Female genital tuberculosis is a symptomless disease inadvertently uncovered during investigation for infertility. The condition is relatively rare and often arises secondary to a primary focus elsewhere. The fallopian tube is the organ most commonly affected. Symptomatic disease usually presents with infertility, pelvic pain or menstrual irregularities. Diagnosis is daunting, even where grounds for suspicion exist. Molecular-based diagnostic methods are likely to play a prominent role in the future. Drug treatment is similar to that of pulmonary tuberculosis, although criteria for assessing the effectiveness of therapy are lacking. Return to fertility after treatment is not encouraging. In-vitro fertilization with embryo transfer remains the most effective method of treating associated infertility. Clinicians need to be aware of the existence of this important cause of infertility in women, in view of the continuing HIV epidemic and the current upsurge in tuberculosis worldwide, as well as the continuing migration of large numbers of women and their families out of areas where tuberculosis is endemic.     

Vascular tumors of the female genital tract: a clinicopathological study of nine cases

The aim of this study was to investigate the clinicopathological features of nine unusual vascular tumors of the female genital tract and to investigate the problems in the differential diagnosis from other genital lesions. MATERIAL-METHODS: In a review of 15,000 specimens of the female genital system examined in our Laboratory during the last decade, nine cases of vascular tumors were found. RESULTS: A capillary hemangioma of the endometrium, one capillary and one cavernous hemangioma of the cervix, six vulva lesions (one capillary, and one cavernous hemangioma and four angiokeratomas) and one hemangiosarcoma of the mons pubis in a 76-year-old patient were diagnosed. CONCLUSIONS: The differential diagnosis of the vascular tumors must be made mainly from endometriotic lesions and melanomas. Immunohistochemistry (S-100, CD31, CD34, CKS, EMA) aid in the diagnosis. Local excision is adequate for the benign vascular lesions.     

Female genital tuberculosis in Ethiopia.

OBJECTIVES: To study the occurrence of female genital tuberculosis (FGTB) in Ethiopia and to compare the different methods available for its diagnosis. METHODS: Biopsy or curettage samples from 25 clinically suspected cases of FGTB were investigated with histopathology, smear microscopy, TB culture and PCR for mycobacteria. HIV status was determined by ELISA. CD4:CD8 ratio was evaluated by flow cytometry. RESULTS: Among the 25 clinically suspected patients investigated, only one was AFB smear positive, three were culture positive, seven were histology positive and 12 were positive by PCR (a total of 16 positives). Samples taken from the fallopian tube were more frequently positive than those from the endometrium. CONCLUSIONS: The results showed that FGTB is a significant clinical problem in Ethiopia. A combination of PCR with the other available methods was found to be the best alternative to achieve sufficient sensitivity and specificity for the diagnosis of FGTB in this setting.     

Aspects of genital tuberculosis in women

Thirteen cases of genital tuberculosis are reported to make emphasis onto the difficulties of diagnosis, management and prognosis of the disease. The average age of the patients is 31 years. Most of them were under 30. The circumstances of diagnosis were variable. The diagnosis was essentially made thanks to histology. The evolution was favorable under antibiotics. But clinical sequels as amenorrhea and infertility are frequent.     

Abdomino-peritoneal tuberculosis masquerading as ovarian cancer: a retrospective study of 26 cases

Purpose  

Evaluation of clinical, laboratory, and operative findings in women of abdomino-pelvic tuberculosis undergoing laparotomy for suspected ovarian cancer.     

Sarcoma botryoides of the uterine cervix in young women: a clinicopathological study of 13 cases

Although the clinical and pathological features of sarcoma botryoides of the vagina in infancy are well documented in the literature, only occasional cases of a histologically similar tumor of the uterine cervix have been described, mostly as individual case reports. We have reviewed 13 cases of sarcoma botryoides of the cervix. The patients range in age from 12 to 26 years, with a mean of 18 years. All presented with vaginal bleeding, "something" protruding from the introitus, or both. On gross examination the tumors were polypoid, smooth, glistening, and focally hemorrhagic. Microscopic examination revealed the presence of a cambium layer and cells showing the features of rhabdomyoblasts in all the cases. Six of the 13 tumors (45%) contained foci of mature cartilage. All the patients were alive and well 1 to 8 years (average 3.5 years) postoperatively except for one who died of the tumor after 1 year. Although most of the patients had a radical operation, sometimes followed by chemotherapy, three had excellent results after polypectomy or cervicectomy. The findings indicate that, unlike its counterpart in the vagina, which has a poor prognosis, sarcoma botryoides of the cervix in young women has a favorable outlook.     

Disseminated peritoneal tuberculosis simulating advanced ovarian cancer: a retrospective study of 17 cases

ObjectivesThe abdominopelvic cavity is one of the common sites for extrapulmonary tubercular infections. The rate of preoperative misdiagnoses between peritoneal tuberculosis (TB) and ovarian cancer is high because of overlapping nonspecific signs and symptoms. We attempted to analyze the experience within our hospital so as to establish the best means of discriminating between peritoneal TB and advanced ovarian cancer.MethodsSeventeen patients diagnosed as having peritoneal TB between July 1986 and December 2008 at the Obstetrics and Gynecology Department of our hospital with the initial presentation simulating advanced ovarian cancer were retrospectively reviewed and evaluated.ResultsPatients’ ages ranged from 24 years to 87 years (median, 38 years). Ten of 17 patients (60%) were younger than 40 years. All patients except one had elevated serum cancer antigen-125 levels with a mean of 358.8 U/mL (range, 12–733 U/mL). Computed tomographic (CT) scans showed ascites with mesenteric or omental stranding in all (100%), enlarged retroperitoneal lymph nodes in six (35.3%), and an adnexal mass in three (17.6%). Abdominal paracentesis was performed in seven cases, in which the findings revealed lymphocyte-dominant ascites without malignant cells. Surgical intervention by laparotomy was performed in 13 cases (76%) and by laparoscopy in three cases (18%), and a CT-guided peritoneal biopsy was performed in one case (6%). A frozen section was taken from 16 patients but not the patient who received a CT-guided peritoneal biopsy, and all revealed granulomatous inflammation. A final pathological examination confirmed a diagnosis of peritoneal TB. All patients responded to anti-TB treatment.ConclusionsIn view of these data, a clinical diagnosis of peritoneal TB should be considered in a relatively young female with nonspecific symptoms of abdominal distension and wasting, as well as lymphocytic ascites without malignant cells. Laparoscopy or a minilaparotomy to obtain tissue samples for frozen-section analysis may be the most direct and least-invasive approach for a diagnosis, thus avoiding unnecessary extended surgery in these patients.     

Hysterosalpingographic findings in infertile women with genital tuberculosis

OBJECTIVES: To evaluate the hysterosalpingographic findings from infertile women who were subsequently diagnosed with genital tuberculosis. METHODS: A retrospective study of 70 infertile women who underwent hysterosalpingography to investigate infertility and were subsequently diagnosed with genital tuberculosis. RESULTS: The mean age of the women was 27.3 years and the mean duration of infertility was 6.1 years. A total of 57 (81.4%) women had primary infertility while 13 had secondary infertility. Diagnosis of genital tuberculosis was made by polymerase chain reaction (54.3%), tuberculous granuloma on biopsy (22.8%), acid-fast bacilli culture (2.8%), and at laparoscopy or hysteroscopy (20%). Hysterosalpingographic findings were a normal uterine cavity observed in 57.1% of women, an irregular cavity in 18.5%, a shrunken cavity in 2.8%, and an irregular filling defect in 18.5%. Synechiae were observed in 17.1% of women. CONCLUSION: Genital tuberculosis is a common cause of infertility in India, causing significant uterine and tubal pathologies.     

Tuberculous endometritis: a clinicopathological study of 1000 cases

Summary. A histopathological diagnosis of tuberculous endometritis was made in 2.3% of 42 770 specimens of non-pregnant endometrial curet-tings and biopsies examined in Delhi. A retrospective analysis of the women with tuberculous endometriosis showed that 62% were in their third decade and the commonest presenting symptoms were infertility (47%) and amenorrhoea (26%). Discrete granulomas were seen in 60%. In the absence of a typical granuloma dilatation of glands, active destruction of epithelium and inflammatory exudate in the lumen suggested tubercular aetiology.     

Vaginal cysts: a clinicopathological study of 41 cases

The clinicopathological features of 43 vaginal cysts in 41 patients treated at Magee-Womens Hospital between 1972 and 1982 were evaluated. Thirty-five of the patients were white and six black; their ages ranged from 19 to 68 years with an average of 37.6 years. Most patients complained of a swelling or mass in the vagina, accompanied in some by stress incontinence, dyspareunia, dysfunctional uterine bleeding, or a history of episiotomies or vaginal lacerations. The majority of the cysts were located in the lateral and posterior walls of the vagina. The most frequent cyst type was mucus-secreting müllerian (19; or 44%), followed by ten (23%) epidermal inclusion cysts; three of the latter were located in a previous episiotomy site. The remainder were five (11%) of Gartner's duct type, three (7%) of Bartholin's duct type, and three (7%) of endometriotic type. The remaining three were unclassified for lack of an epithelial lining in two, and one cystourethrocele was confused with a vaginal cyst. None disclosed atypical epithelial hyperplasia or malignant change.     

女性生殖道感染1111例调查分析

目的为进一步了解女性生殖道感染性疾病的发病情况及影响发病的相关因素,提出防治疾病的干预措施。方法1111例来自妇科门诊病人、早孕要求终止妊娠妇女、来本院健康体检的工人、农民、机关干部及性乱妇女,通过问卷调查了解其职业、受教育情况、经济状况、卫生习惯、性卫生习惯等情况,同时对每位妇女进行常规妇科检查及有关病原体实验室检查。结果1111例妇女年龄范围为15～66岁,平均(32.7±8.85)岁。经期使用不消毒月经垫、不洗外阴者分别占5.7％及19.9％。卫生习惯以农民组较差(P＜0.01)。平均初次性生活年龄为23.6岁,小于平均结婚年龄24.4岁。婚前性生活经历尤以性乱组明显(P＜0.01),性生活频繁、多个性伴侣、性交前后不清洗外阴及口交、肛交等多样性交方式也以性乱组比例最高(P＜0.01)。生殖道普通炎症患病率为97.7％,以宫颈炎症性疾病为主,为56.0％,其次为外阴阴道炎、盆腔炎,分别为35.6％及6.1％。性传播疾病(STD)检出率平均为52.7％,以滴虫为主,为11.7％,其次为淋病9.4％、乙肝病毒感染8.0％、衣原体7.8％、人乳头状瘤病毒5.7％、白色念珠菌感染4.0％、巨细胞病毒2.7％、单纯疱疹病毒2.3％、脲支原体1.1％。普通妇科炎症及STD患病率均以性乱组为高(P＜0.01)。该组人群还具有文化程度低、以服务性行业人员为主、婚前流产史比例高、多种STD或多种普通妇科炎症同时感染等特征。结论普通妇科炎症性疾病及STD是危害妇女健康重要原因之一。发病率与职业、卫生习惯、性卫生、性道德等密切相关,防治妇科炎症性疾病及STD的关键为早期诊断治疗,切断STD传播途径,重点是性乱人群。